Mitral balloon valvotomy for patients with mitral stenosis in atrial fibrillation

Leon, Miltiadis N; Harrell, Lari; Simosa, Hector F.; Mahdi, Nasser A; Pathan, Asad; López-Cuellar, Julio; Inglessis, Ignacio; Moreno, Pedro R.; Palacios, Igor F.

doi:10.1016/s0735-1097(99)00310-1

Cited by 34 publications

(16 citation statements)

References 41 publications

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“…Thus, patients in AF with MES ≤8 had equal postprocedure and follow-up MVA compared to patients in sinus rhythm. These findings concur with reports of other investigators [22, 23]. …”

Section: Discussionsupporting

confidence: 94%

“…AF occurs more frequently in older patients and is associated with inferior immediate and long-term results after MBV, a finding that concurs with the reports of other investigators [22,23,24,25]. However, the presence of AF by itself does not unfavorably influence the outcome but is a marker for clinical and morphological features associated with inferior results after MBV.…”

Section: Discussionsupporting

confidence: 90%

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Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Fawzy¹,

Shoukri

Fadel³

et al. 2009

Cardiology

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Objectives: The study aim was to assess the long-term results (up to 18 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival. Methods: The immediate and long-term results for 531 consecutive patients (mean age 31 ± 11 years) who underwent successful MBV and were followed up for a mean of 8.5 ± 4.8 years (range: 1.5–18 years) are reported. Results: The mitral valve area (MVA) increased from 0.92 ± 0.17 to 1.95 ± 0.29 cm² (p < 0.0001). Restenosis was 31 and 19% in patients with mitral echocardiographic score (MES) ≤8. Actuarial freedom from restenosis at 10, 15 and 18 years was 77 ± 2, 46 ± 3 and 18 ± 4% and 86 ± 2, 62 ± 4 and 31 ± 7% for MES ≤8, respectively (p < 0.001). Event-free survival (death, redo MBV, mitral valve replacement, NYHA class III or IV) at 10, 15 and 18 years was 88 ± 1, 53 ± 4, and 21 ± 5% and 93 ± 2, 65 ± 5 and 38 ± 8% for MES ≤8, respectively (p < 0.001). Multivariable Cox regression analysis identified MES >8 (p < 0.0001) and previous surgery (p = 0.043) as predictors of restenosis, and MES >8 (p < 0.0001) and baseline atrial fibrillation (p = 0.03) as predictors of combined events. Conclusion: MBV provides excellent long-term results. The baseline clinical and MES characteristics are predictors of outcome.

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“…Thus, patients in AF with MES ≤8 had equal postprocedure and follow-up MVA compared to patients in sinus rhythm. These findings concur with reports of other investigators [22, 23]. …”

Section: Discussionsupporting

confidence: 94%

Section: Discussionsupporting

confidence: 90%

Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Fawzy¹,

Shoukri

Fadel³

et al. 2009

Cardiology

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“…10-12,14,15 Similar to other studies, we also found that the results of PBMV in AF patients are poor compared to SR with increased short and long term adverse events. 12-15 Leon et al showed that patients with AF had higher TMPG and smaller MVA before PBMV and higher mean LAP after PBMV. 12 Fawzy et al found that patients with AF had smaller MVA and more re-stenosis after PBMV.…”

Section: Discussionsupporting

confidence: 78%

“…1,2 Percutaneous balloon mitral valvotomy (PBMV) is performed as preferred alternative to surgery for most patients with hemodynamically significant MS. 3-9 Atrial fibrillation (AF) is the most common arrhythmia that occurs in 40%-75% of symptomatic patients with MS. 10,11 Several studies have shown that AF affects short and long term outcomes and the mortality risk of PBMV and in most cases it has been associated with a decreased success rate of PBMV and a worse clinical outcome. 12-18 So considering that the previous studies have been conducted on a smaller number of patients, this study aimed at investigating the immediate success rates of PBMV, short and long term results, and mortality risk in patients with MS and AF compared to sinus rhythm (SR) in a large data base. …”

Section: Introductionmentioning

confidence: 99%

Poor outcome following percutaneous balloon mitral valvotomy in patients with atrial fibrillation

Aslanabadi¹,

Ghaffari²,

N³

et al. 2016

J Cardiovasc Thorac Res

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Introduction: Atrial fibrillation (AF) is the most common arrhythmia in patients with mitral stenosis (MS) and it may increase complications and decreases success rates of percutaneous balloon mitral valvotomy (PBMV). This study aimed to investigate the short and long term results of PBMV in patients with AF compared to sinus rhythm (SR). Methods: In this cross sectional study, 1000 patients with MS who had undergone PBMV between 1999 and 2013 were enrolled including 585 and 415 patients with AF and SR respectively. Patients were followed for a mean of 7.27 ± 3.16 years. Clinical, echocardiographic and hemodynamic data were collected. Procedure success, in-hospital and long-term outcome were evaluated. Results: Patients with AF were older and had greater symptoms, mitral regurgitation, mitral echocardiographic score, and mitral pressure gradient before PBMV. PBMV success rate were significantly lower in AF group (P < 0.001). In-hospital complications, including severe mitral regurgitation, emergency mitral valve surgery, peripheral embolism and long-term complications, including mortality, re-valvotomy, mitral replacement surgery and peripheral embolism/stroke were significantly higher in patients with AF. Conclusion: AF leads to worse in-hospital and long-term outcome and lower PBMV success rate. Repeated assessment and early decision to PBMV in patients with MS to reduce AF and AF related complication seems necessary.

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“…Factors that have been identified include preprocedural parameters such as (1) patient's age as an independent predictor of both immediate and long-term outcomes,20 49 (2) NYHA class IV at presentation, (3) MVA, (4) previous surgical commissurotomy, (5) presence of MR, (6) Wilkins echo score ≤8 and (7) presence of tricuspid regurgitation 50. Postprocedural parameters associated with long-term outcomes include (1) immediate result of the PMC procedure, where the post-PMC MVA of ≥1.8 cm 2 has been shown to have good outcomes;45 (2) presence of postprocedural MR; (3) mean mitral gradient after PMC; (4) pulmonary artery pressure;20 (5) development of significant late tricuspid regurgitation even in the absence of pulmonary hypertension;51 (6) progressive increase of left atrial (LA) volume even after successful PMC;52 and (7) the presence of AF 53…”

Section: Long-term Outcome After Pmcmentioning

confidence: 99%

Update on percutaneous mitral commissurotomy

Nunes

Nascimento

Lodi-Junqueira

et al. 2016

Heart

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Percutaneous mitral commissurotomy (PMC) is the first-line therapy for managing rheumatic mitral stenosis. Over the past two decades, the indications of the procedure have expanded to include patients with unfavourable valve anatomy as a consequence of epidemiological changes in patient population. The procedure is increasingly being performed in patients with increased age, more deformed valves and associated comorbidities. Echocardiography plays a crucial role in patient selection and to guide a more efficient procedure. The main echocardiographic predictors of immediate results after PMC are mitral valve area, subvalvular thickening and valve calcification, especially at the commissural level. However, procedural success rate is not only dependent on valve anatomy, but a number of other factors including patient characteristics, interventional management strategies and operator expertise. Severe mitral regurgitation continues to be the most common immediate procedural complication with unchanged incidence rates over time. The long-term outcome after PMC is mainly determined by the immediate procedural results. Postprocedural parameters associated with late adverse events include mitral valve area, mitral regurgitation severity, mean gradient and pulmonary artery pressure. Mitral restenosis is an important predictor of event-free survival rates after successful PMC, and repeat procedure can be considered in cases with commissural refusion. PMC can be performed in special situations, which include high-risk patients, during pregnancy and in the presence of left atrial thrombus, especially in centres with specialised expertise. Therefore, procedural decision-making should take into account the several determinant factors of PMC outcomes. This paper provides an overview and update of PMC techniques, complications, immediate and long-term results over time, and assessment of suitability for the procedure.

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Mitral balloon valvotomy for patients with mitral stenosis in atrial fibrillation

Abstract: Patients with AF have a worse immediate and long-term outcomes after PMV. However, the presence of AF by itself does not unfavorably influence the outcome, but is a marker for clinical and morphologic features associated with inferior results after PMV.

Cited by 34 publications

References 41 publications

Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Long-Term (up to 18 Years) Clinical and Echocardiographic Results of Mitral Balloon Valvuloplasty in 531 Consecutive Patients and Predictors of Outcome

Poor outcome following percutaneous balloon mitral valvotomy in patients with atrial fibrillation

Update on percutaneous mitral commissurotomy

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