Long term outcome of percutaneous mitral balloon valvotomy in patients aged 70 and over

OBJECTIVE: To assess the immediate haemodynamic improvement and long term symptomatic benefit of percutaneous mitral balloon valvotomy in patients aged over 70 years. DESIGN: Pre- and postprocedure haemodynamic data and follow up for 1 to 10 years by clinic visit or telephone contact. SETTING: Tertiary referral centre in Scotland. SUBJECTS: 80 patients age 70 and over who had mitral balloon dilatation: 55 were considered unsuitable for surgical treatment because of frailty or associated disease. In an additional four patients mitral dilatation was not achieved. MAIN OUTCOME MEASURES: Increase in valve area after balloon dilatation and survival, freedom from valve replacement, and symptom class at follow up. RESULTS: Mean (SD) valve area increased by 89% from 0.84 (0.28) to 1. 59 (0.67) cm(2). There was a low rate of serious complications, with only two patients having long term major sequelae. Of 55 patients unsuitable for surgical treatment, 28 (51%) were alive without valve replacement and with improvement by at least one symptom class at one year, and 14 (25%) at five years. In the 25 patients considered suitable for surgical treatment, 16 (64%) achieved this outcome at one year and nine (36%) at five years. CONCLUSIONS: Percutaneous mitral balloon valvotomy is a safe and useful palliative procedure in elderly patients who are unsuitable for surgery. Balloon dilatation should also be used for elderly patients whose valve appears suitable for improvement by commissurotomy, but echo score is an imperfect predictor of haemodynamic improvement.