Temporal trends in percutaneous mitral commissurotomy over a 15-year period

Iung, Bernard; Nicoud-Houel, Alexane; Fondard, Olivier; Akoudad, Hafid; Haghighat, Tinouch; Brochet, Éric; Garbarz, Eric; Cormier, Bertrand; Baron, Gabriel; Luxereau, P; Vahanian, Alec

doi:10.1016/j.ehj.2004.02.026

Cited by 82 publications

(24 citation statements)

References 26 publications

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“…Aunque la prevalencia de enfermedad reumá-tica ha disminuido progresivamente en el mundo 8 , la EM aún es una condición que se presenta en Chile. Su tratamiento de referencia en la actualidad es la VMB 2 .…”

Section: Discussionunclassified

Resultados a largo plazo de la valvuloplastía mitral con balón

et al. 2014

Rev. méd. Chile

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Section: Discussionunclassified

Resultados a largo plazo de la valvuloplastía mitral con balón

et al. 2014

Rev. méd. Chile

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“…Of the 112 patients with poor immediate results, 80 underwent early mitral surgery with a median duration of 1 month after PMC (interquartile range [1][2][3][4][5][6][7][8][9][10][11][12][13][14]. Of the 32 nonoperated patients, 22 died (Table 2).…”

Section: Whole Populationmentioning

confidence: 99%

“…With growing experience, indications of PMC have been progressively widened to include less favorable conditions. [2][3][4] The ability to predict individual patient outcome is therefore of importance in clinical practice. A number of series have reported late results after PMC.…”

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confidence: 99%

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Bouleti

Iung²,

Laouénan³

et al. 2012

Circulation

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Background— Long-term follow-up after percutaneous mitral commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm 2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P <0.0001), interaction between age and final mitral valve area ( P <0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification ( P <0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation ( P <0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. Conclusions— Twenty years after percutaneous mitral commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.

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“…7 Although increases in mitral valve area after PMV are largely the result of separation of the mitral leaflets along the natural planes of their commissures, 8 -11 many additional mechanisms have been reported to contribute to the development of significant MR after PMV, including excessive commissural split and disruption of chordal or valvular anatomy. 12 In addition, clinical tolerance to immediately produced significant MR is variable, and although some patients require emergency surgery, others do not need it, and a few may even have a decrease in the severity of MR over time.…”

Section: Clinical Perspective P 2822mentioning

confidence: 99%

Long-Term Outcomes of Significant Mitral Regurgitation After Percutaneous Mitral Valvuloplasty

Kim

Song

et al. 2006

Circulation

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Background-Mild commissural mitral regurgitation (MR) is associated with significantly higher restenosis-free survival after percutaneous mitral valvuloplasty (PMV), which suggests that different mechanisms of significant MR after PMV may have different clinical courses. We therefore analyzed long-term prognostic factors of significant MR after PMV. Methods and Results-Echocardiographic and clinical follow-up data on 380 patients were analyzed (286 women, mean age 44Ϯ11 years) who underwent PMV with the Inoue balloon technique between 1995 and 2000. Significant MR developed in 47 patients (12.4%). The survival rate at 8 years was 96Ϯ3% and 98Ϯ10% in patients with and without significant MR, respectively (Pϭ0.084). The most frequent mechanism was commissural MR, or MR that originated at the site of successful commissurotomy, which occurred in 27 of 47 patients (57%), whereas noncommissural MR occurred in 20 (43%) patients, 12 (26%) with subvalvular damage resulting in chordae rupture and flail motion and 8 (17%) with leaflet laceration. The 8-year event-free survival rate was significantly lower in patients with significant MR than in those without (47Ϯ8% versus 83Ϯ3%, PϽ0.001) and was significantly higher in patients with commissural versus noncommissural MR (63Ϯ11% versus 29Ϯ11%, PϽ0.001). Of the 47 patients with significant MR, who were followed up for 74Ϯ29 months, 19 patients (40%) underwent mitral valve replacement, and 28 patients (60%) received medical treatment only. Patients with commissural MR had a significantly lower rate of mitral valve replacement than patients with noncommissural MR (15% versus 70%, PϽ0.001). Multivariate analysis showed that atrial fibrillation (odds ratio, 7.4; 95% CI, 1.1 to 56.4; Pϭ0.038), mean mitral gradient immediately after PMV (odds ratio, 1.5; 95% CI, 1.1 to 2.0; Pϭ0.009), and the mechanism of MR (odds ratio, 16.7; 95% CI, 2.3 to 122.2; Pϭ0.005) were independent factors associated with mitral valve replacement. Conclusions-Clinical outcome of patients with significant MR after PMV varied according to MR mechanism and the adequacy of hemodynamic improvement, which is easily assessed by echocardiography immediately after PMV.

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Temporal trends in percutaneous mitral commissurotomy over a 15-year period

Cited by 82 publications

References 26 publications

Resultados a largo plazo de la valvuloplastía mitral con balón

Resultados a largo plazo de la valvuloplastía mitral con balón

Late Results of Percutaneous Mitral Commissurotomy up to 20 Years

Long-Term Outcomes of Significant Mitral Regurgitation After Percutaneous Mitral Valvuloplasty

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