Predictors of mitral valve replacement after percutaneous mitral valvuloplasty

Abstract EN

Percutaneous mitral valvuloplasty (PVM) is an effective therapy for mitral stenosis in selected patients.

Nonetheless, mitral valve replacement (MVR) may be still required after PVM in some cases.

The aim of this analysis is to assess predictors of MVR after PVM.

Our retrospective study includes 354 patients enrolled in our department (1996-2002).

Thirty seven (10, 34%) of 354 patients underwent MVR at a mean interval of 13, 6±9,3 months after PVM.

No major differences were apparent in the demographic features of patients who did or did not undergo surgery.

Five patients (13%) underwent surgery within the first month after PVM while 32 patients (87%) were operated later.

On univariate analysis several predictors were brought out: rheumatic antecedents, commissurotomy history, atrial fibrillation, severe mitral regurgitation before PVM or its aggravation after PVM, high echocardiography score, calcification, small mitral area, mitral gradient, diastolic and systolic arterial pulmonary pressure before PVM.

However, on multivariate analysis only mitral area, diastolic and systolic arterial pulmonary pressure could be predictors for surgery.

Certainly, PVM is an excellent treatment option in mitral stenosis.

It is minimally invasive, well-tolerated and has a high success rate.

But the need of surgery after PVM is not uncommon, so if a mitral valve restenosis occurred in patients with predictors of surgery, do we repeat PVM or directly perform RMV ?