Key result
Prior percutaneous mitral valvuloplasty was associated with lower rates of death, MVR, or repeat BMV compared to prior closed valvotomy (7.1% vs 31.2%, P=0.027) in patients with mitral restenosis.
Why the study?
Does percutaneous mitral valvuloplasty for mitral restenosis yield better outcomes in patients with prior BMV compared to those with prior closed mitral valvotomy?
Cohort (n=92)
Does percutaneous mitral valvuloplasty for mitral restenosis yield better outcomes in patients with prior BMV compared to those with prior closed mitral valvotomy?
Absolute Event Rate: 7.1% vs 31.2%
p-value: p=0.027
Patients undergoing percutaneous mitral valvuloplasty for mitral restenosis have better long-term event-free survival if their initial procedure was BMV rather than closed mitral valvotomy, despite similar procedural success rates.
May favor initial percutaneous over closed valvotomy in mitral stenosis; leaves open confirmation in prospective trials.
AIM: To compare the results of percutaneous mitral valvuloplasty (BMV) for mitral restenosis in post-BMV versus postclosed mitral valvotomy (CMV) patients. METHODS AND RESULTS: Ninety-two patients who underwent BMV for mitral restenosis were followed up prospectively. Of these, 28 patients had undergone previous percutaneous mitral valvuloplasty (PRIOR BMV) and 64 patients had undergone previous closed mitral valvotomy (PRIOR CMV). BMV for mitral restenosis was a success in 59% patients (57.1% PRIOR BMV, 59.3% PRIOR CMV, P = 1.0). Incidence of severe mitral regurgitation was 3.25%, all in the PRIOR CMV group. In univariate analysis, the major predictor of successful BMV for mitral restenosis was Wilkins score (P = 0.004). At a follow up of 3.47 + 2.07 years, mitral valve area was similar between groups (1.45 +/- 0.22, 1.46 +/- 0.26, P = 0.35). The combined end points of mitral valve replacement (MVR), need for re-repeat BMV for mitral restenosis or death was higher in the PRIOR CMV group (31.2% PRIOR CMV, 7.1% PRIOR BMV, P = 0.027). Event-free survival at follow up was lower in the PRIOR CMV group (69% PRIOR CMV, 92.8% PRIOR BMV) mainly due to the higher need for MVR (11 vs. 0 patients, P = 0.03). CONCLUSIONS: In conclusion, following BMV for mitral restenosis, patients with PRIOR BMV are found to have lesser event rates on follow-up compared to patients with PRIOR CMV, though procedural success rates are similar.
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Nair et al. (2010) conducted a cohort in Mitral restenosis (n=92). Previous percutaneous mitral valvuloplasty (PRIOR BMV) vs. Previous closed mitral valvotomy (PRIOR CMV) was evaluated on Combined end points of mitral valve replacement (MVR), need for re-repeat BMV for mitral restenosis or death (p=0.027). Prior percutaneous mitral valvuloplasty was associated with lower rates of death, MVR, or repeat BMV compared to prior closed valvotomy (7.1% vs 31.2%, P=0.027) in patients with mitral restenosis.
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