Why the study?
The prevalence of rheumatic mitral stenosis has significantly changed over recent decades, motivating an examination of 30-year trends in patient demographics, echocardiographic characteristics, procedural success rates, and complications of percutaneous balloon mitral valvuloplasty.
What are the 30-year clinical and echocardiographic trends, procedural complication rates, and independent predictors of mitral valve replacement and heart failure in patients undergoing percutaneous balloon mitral valvuloplasty?
Observational (n=417)
No
What are the 30-year clinical and echocardiographic trends, procedural complication rates, and independent predictors of mitral valve replacement and heart failure in patients undergoing percutaneous balloon mitral valvuloplasty?
Answers are grounded in this paper and cite their sources.
Over 30 years of percutaneous balloon mitral valvuloplasty, patients presented with increasingly complex calcified valves and more comorbidities, with Wilkins score >8, post-procedural MR ≥2, and post-procedural MVA <1.5 cm2 serving as strong independent predictors of subsequent mitral valve replacement and heart failure.
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 Our research reveals trends over time in patients' characteristics and echocardiographic features. Our study population consists of more male patients with multiple comorbidities and more complex and calcified valvular structures in the last decade. Wilkins score >8, post-procedural MR of ≥2, and post-procedural MVA <1.5 cm2 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 undergoing percutaneous balloon mitral valvuloplasty (PBMV) (n=417). Percutaneous balloon mitral valvuloplasty (PBMV) and echocardiographic/procedural predictors (Wilkins score >8, post-procedural MR ≥2, post-procedural MVA <1.5 cm2) was evaluated on Procedural complications, need for mitral valve replacement (MVR) surgery within 2 years, and development of heart failure (HR 10.06, p=<.0001).
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