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. 2022 Oct;12(5):552-562.
doi: 10.21037/cdt-22-140.

Procedural success and outcomes after percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis with moderate mitral regurgitation: a retrospective cohort study

Ply Chichareon  1   2 , Thanapon Nilmoje  1 , Saranyou Suwanugsorn  1 , Noppadol Chamnarnphol  1 , Metus Thungthienthong  3 , Sarayuth Lucien Geater  4 , Woravut Jintapakorn  1   2
Affiliations

Procedural success and outcomes after percutaneous balloon mitral valvuloplasty in rheumatic mitral stenosis with moderate mitral regurgitation: a retrospective cohort study

Ply Chichareon et al. Cardiovasc Diagn Ther. 2022 Oct.

Abstract

Background: Percutaneous balloon mitral valvuloplasty (PBMV) is contraindicated in mitral stenosis (MS) with moderate mitral regurgitation (MR) according to the European guidelines. However, small-sized studies have demonstrated the feasibility and safety of PBMV in these patients. We aimed to study the procedural success and mid-term outcomes of PBMV in MS patients with moderate MR.

Methods: The present study was a retrospective cohort study in consecutive patients with severe rheumatic MS who underwent PBMV with the Inoue technique in Songklanagarind hospital. The severity of mitral regurgitation was assessed with qualitative Doppler. The patients were grouped according to their MR severity before PBMV into moderate MR or less-than-moderate MR. Procedural success and a composite of all-cause death, mitral valve surgery or re-PBMV were compared between the two groups.

Results: Of 618 patients with rheumatic MS who underwent PBMV in Songklanagarind hospital between January 2003 and October 2020, 598 patients (96.8%) had complete information of pre-PBMV MR severity and procedural success. Forty-nine patients (8.2%) had moderate MR before PBMV. Moderate MR before PBMV was not associated with a lower chance of PBMV success (moderate MR vs. less-than-moderate MR before PBMV; adjusted OR 0.65, 95% CI: 0.32-1.29, P=0.22). Survival probability of all-cause death, MV surgery or re-PBMV in the group with moderate MR before PBMV was not different from the group with less-than-moderate MR (adjusted HR 1.30, 95% CI: 0.98-1.62, P=0.10).

Conclusions: PBMV is an effective and safe treatment in rheumatic MS with moderate MR.

Keywords: Rheumatic mitral stenosis; mitral regurgitation (MR); percutaneous balloon mitral valvuloplasty (PBMV); procedural success.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://cdt.amegroups.com/article/view/10.21037/cdt-22-140/coif). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Flow of study population. MS, mitral stenosis; PBMV, percutaneous balloon mitral valvuloplasty; LA, left atrium; TEE, transesophageal echocardiography; MR, mitral regurgitation.
Figure 2
Figure 2
Changes in MR severity after PBMV according to pre-PBMV MR severity. PBMV, percutaneous balloon mitral valvuloplasty; MR, mitral regurgitation.
Figure 3
Figure 3
Kaplan-Meier survival curves (A) and adjusted survival probability of a composite of all-cause death, mitral valve surgery or re-PBMV (B) according to MR severity before PBMV. PBMV, percutaneous balloon mitral valvuloplasty; MR, mitral regurgitation.
Figure 4
Figure 4
Kaplan-Meier survival curves (A) and adjusted survival probability of composite of all-cause death, mitral valve surgery or re-PBMV (B) among patients with different post-PBMV MR severity. *, Adjusted hazard ratio for the composite of all-cause death, MV surgery or re-PBMV using no or trivial MR after PBMV as a reference. PBMV, percutaneous balloon mitral valvuloplasty; MR, mitral regurgitation.
See this image and copyright information in PMC

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