Key result
Over a 30-year period, the procedural success rate of percutaneous balloon mitral valvuloplasty decreased from 97.0% in 1990-1999 to 85.7% in 2010-2019 (age-adjusted OR 0.20, p=0.005), reflecting an increase in patient comorbidities and valve complexity.
Why the study?
Because the prevalence of rheumatic mitral stenosis has significantly changed over the last decades, the authors intended to examine patient demographics, echocardiographic characteristics, procedural success rates, and complications over 30 years.
Observational (n=417)
No
Odds Ratio: 0.2
Absolute Event Rate: 85.7% vs 97%
p-value: p=0.005
Over a 30-year period, patients undergoing PBMV for rheumatic mitral stenosis presented with increasing comorbidities and complex valve morphology, with post-procedural MVA <1.5 cm2, MR ≥2, and Wilkins score >8 strongly predicting the need for future mitral valve surgery and heart failure hospitalization.
Identifies high-risk phenotypes for early surgical intervention after percutaneous balloon mitral.
BACKGROUND: The prevalence of Rheumatic Mitral Stenosis (MS) has significantly changed over the last decades. We intend to examine patient demographics, Echocardiographic characteristics, procedural success rates, and complications throughout 30-years. METHODS: We conducted a single-center descriptive observational study. The study population consists of patients undergone percutaneous balloon mitral valvuloplasty (PBMV) at Emek Medical Center in Israel from January 1990 to May 2019. RESULTS: Four hundred seventeen patients underwent PBMV during the study period and were eligible for the study. Age did not change significantly over time (p = 0.09). The prevalence of Male and patients who were smoking and had multiple comorbidities such as hypertension, dyslipidemia, ischemic heart disease, and chronic kidney disease became increases over time (p = 0.02, p = 0.02, p = 0.001, p = 0.01, p = 0.02, and p = 0.001, respectively). Wilkins score and all its components increased over time, and the total score was higher in females (p = 0.01). Seventy-nine (18.9%) patients had complications. The rate of complications did not change over decades. Patients with Wilkins score > 8, post-procedural MR of ≥2, and post-procedural MVA < 1.5 had the highest risk for the need of Mitral valve replacement (MVR) surgery in 2 years following PBMV (3.64, 4.03, 2.44, respectively, CI 95%, p < .0001 for all). The median time in these patients was 630 days compared to 4-5 years in the entire population. Patients with Post-procedural MR of ≥2 and post-procedural MVA < 1.5 had ten times risk for developing heart failure (HR 9.07 and 10.06, respectively, CI 95%, P < .0001). CONCLUSION: were in-depended predictors for the time for surgery and heart failure hospitalization.
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Koren et al. (2021) conducted an observational in Rheumatic Mitral Stenosis (n=417). Percutaneous balloon mitral valvuloplasty (PBMV) vs. Earlier decades (1990-1999) was evaluated on Procedural success rate (mitral valve area dilatation to ≥1.5 cm2) (OR 0.20, p=0.005). Over a 30-year period, the procedural success rate of percutaneous balloon mitral valvuloplasty decreased from 97.0% in 1990-1999 to 85.7% in 2010-2019 (age-adjusted OR 0.20, p=0.005), reflecting an increase in patient comorbidities and valve complexity.
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