Intermediate outcomes of rheumatic mitral stenosis post-balloon mitral valvotomy. (October 2015)

• Record Type: Journal Article
• Authors: Sharma, Jugal; Goel, Pravin K; Pandey, Chandra Mani; Awasthi, Ashish; Kapoor, Aditya; Tewari, Satyendra; Garg, Naveen; Kumar, Sudeep; Khanna, Roopali
• Is Part Of: Asian cardiovascular & thoracic annals. Volume 23:Number 8(2015)
• Page Start: 923
• Page End: 930
• Publication Date: 2015-10
• Subjects: Cardiac catheterization -- Dilatation -- Follow-up studies -- Mitral valve stenosis -- Rheumatic heart disease; Heart -- Diseases -- Asia -- Periodicals; Heart -- Diseases -- Pacific Area -- Periodicals; Heart -- Diseases -- Periodicals; Heart -- Surgery -- Asia -- Periodicals; Heart -- Surgery -- Pacific Area -- Periodicals; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Asia -- Periodicals; Chest -- Surgery -- Pacific Area -- Periodicals; Chest -- Surgery -- Periodicals; 617.412
• DOI: 10.1177/0218492315598240
• Languages: English
• ISSNs: 0218-4923

Abstract

Background: Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Data on intermediate outcomes of this procedure are limited. Thus we investigated the intermediate outcome after balloon mitral valvotomy performed at a large tertiary center in India. Methods: Case records and follow-up data of 2330 patients who underwent valvotomy from June 1999 to December 2005 were retrieved from the hospital information system and analyzed. Results: The median age of the patients was 32 ± 11 years, 1363 were female including 36 who were pregnant, and 379 were in atrial fibrillation. Follow-up ranged from 1 to 14 years (mean 4.5 years, median 4.0 years). The procedural success rate was 93%. Atrial fibrillation, higher functional class, and worse valve morphology were independent predictors of a poor procedural outcome. Patients with sinus rhythm had better event-free survival (10.43 years, 95% confidence interval: 10.1–10.7) compared to those with atrial fibrillation (8.17 years, 95% confidence interval: 7.5–8.8). Patients who achieved a valve area >1.75 cm 2 had a better event-free survival (11.7 years, 95% confidence interval: 11.4–12.0) than those with a valve area of 1.5–1.74 cm 2 (9.3 years, 95% confidence interval: 9.0–9.7). On multivariate analysis, higher functional class, worse valve morphology, and new significant mitral regurgitation were predictors of a poor outcome. Achieved mitral valve area >1.75 cm 2 was an independent predictor of a good outcome. Conclusion: Patients with sinus rhythm, less gross valve deformity, and a post-balloon mitral valvotomy area >1.75 cm 2 had better intermediate outcomes.