Comparative Efficacy and Safety of Echocardiography Versus Radiation Guidance in Percutaneous Balloon Mitral Valvuloplasty: A Retrospective Study

Background: Percutaneous balloon mitral valvuloplasty (PBMV) is the preferred treatment for selected patients with rheumatic mitral stenosis (MS). Although prior research has established the feasibility and safety of echocardiography-guided PBMV, this study aimed to compare the mid- to long-term clinical outcomes and safety profiles between echocardiography-guided and conventional fluoroscopy-guided approaches. Methods: Consecutive patients who underwent successful PBMV from January 2016 to December 2022 were enrolled. Participants were stratified into two groups based on procedural guidance method: echocardiography-guided and conventional fluoroscopy-guided. The primary outcome of this study was the success of PBMV, and the secondary outcome was a composite of all-cause mortality, reoperation for mitral valve surgery, or repeat PBMV after discharge. Statistical analyses included the Kaplan–Meier survival analysis with log-rank tests and propensity score matching to adjust for confounding factors. Results: A total of 429 patients underwent PBMV, with 71 (16.6%) in the echo-guided group and 358 (83.4%) in the conventional fluoroscopy-guided group. A success rate of 98.6% was demonstrated in the echocardiography-guided group, and 98.9% in the fluoroscopy-guided group after propensity score match (p = 0.84). During follow-up, nine (14.3%) patients in the echo-guided group required surgical intervention, and 13 (10.4%) in the fluoroscopy-guided group; one (1.6%) patient in the echocardiography-guided group and six (4.8%) in the fluoroscopy-guided group died. No significant differences were observed in freedom from re-intervention (p = 0.33) and survival (p = 0.23). Conclusions: For selected patients with rheumatic MS, echocardiography-guided PBMV demonstrated an equivalent mid- to long-term efficacy and safety profile compared to fluoroscopy-guided approaches.