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  • Title: Repeat percutaneous mitral balloon valvuloplasty for patients with mitral valve restenosis.
    Author: Chmielak Z, Klopotowski M, Kruk M, Demkow M, Konka M, Chojnowska L, Hoffman P, Witkowski A, Ruzyllo W.
    Journal: Catheter Cardiovasc Interv; 2010 Dec 01; 76(7):986-92. PubMed ID: 20506140.
    Abstract:
    OBJECTIVES: To determine immediate and long-term clinical outcome, as well prognostic factors in patients who underwent repeat percutaneous mitral balloon valvuloplasty (PMBV). BACKGROUND: Repeat PMBV may be a method of treatment for symptomatic patients with restenosis after successful initial PMBV, but data regarding its long term safety and efficacy are scarce. METHODS: The study group consisted of 67 patients (mean age 52.1 ± 10.5 years). All PMBV procedures were performed using the Inoue balloon system. RESULTS: Repeat PMBV resulted in significant increase in MVA from 1.17 ± 0.16 cm(2) to 1.63 ± 0.22 cm(2) (P < 0.001). Good immediate result (MVA ≥1.5 cm(2) , mitral regurgitation ≤2) was obtained in 52 (77.6%) patients and was not predicted by any analyzed factors. During follow-up (mean time 4.9 ± 2.9 years) six patients died, nine underwent mitral valve replacement, four-third PMBV, and four developed heart failure. The 3-, 5-, and 8-year good functional results (survival free of mitral valve replacement, third PMBV or heart failure ≥ NYHA III) by Kaplan-Meier estimates were 89.3, 75.6, and 52.6%, respectively. These results were significantly superior in patients with good immediate results and echo score <7. In the entire population multivariate Cox regression analysis identified echo score <7 and absence of prior surgical commissurotomy as the independent predictors of event-free survival. CONCLUSIONS: Repeat PMBV is safe and provides good immediate results in patients with restenosis after successful first procedure. Long-term results of repeat PMBV are satisfactory and related mainly to the echo score and quality of the procedure.
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