Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis

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• 作者：Elisabete Jorge ; MD^a ; ^{elisabetejorge@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Manuel Pan ; MD ; PhD^b ; Rui Baptista ; MD^a ; ^c ; Miguel Romero ; MD ; PhD^b ; Soledad Ojeda ; MD ; PhD^b ; Javier Suá ; rez de Lezo ; MD ; PhD^b ; Henrique Faria ; MD^a ; Joã ; o Calisto ; MD^a ; Pedro Monteiro ; MD ; PhD^a ; ^c ; Mariano Pê ; go ; MD^a ; José ; Suá ; rez de Lezo ; MD ; PhD^b
• 刊名：The American Journal of Cardiology
• 出版年：2016
• 出版时间：15 June 2016
• 年：2016
• 卷：117
• 期：12
• 页码：1978-1984
• 全文大小：718 K

文摘

Data on long-term outcomes of percutaneous mitral valvuloplasty (PMV) are still scarce. In addition, the persistence of pulmonary hypertension (PH) after PMV is a complication for which mechanisms and prognostic implications are unclear. Our aims were (1) to report the long-term outcomes of patients with rheumatic mitral stenosis treated with PMV; (2) to determine the risk factors for long-term poor outcomes; and (3) to analyze the prevalence and predictors of persistent PH. We prospectively enrolled 532 patients who underwent PMV from 1987 to 2011 at 2 hospitals. The following end points were assessed after PMV: all-cause mortality, mitral reintervention, a composite end point of all-cause mortality and mitral reintervention, and PH persistence. Survival status was available for 97% patients; the median follow-up was 10 years (interquartile range 4 to 18 years). Procedural success was achieved in 85% patients. During the follow-up, 21% patients died and 27% required mitral reintervention. Before PMV, 74% patients had PH that persisted after PMV in 45% of patients (p <0.001). Unfavorable valve anatomy (Wilkins score >8) and post-PMV mean pulmonary arterial pressure (PAP) were independent predictors of all-cause mortality, mitral reintervention, and the composite end point. Post-PMV mean PAP was significantly correlated with a mitral valve area (MVA) <2.5 cm² (p <0.001); in addition, on the echocardiographic follow-up, MVA was an independent predictor of systolic PAP (p <0.001). In conclusion, PMV represents an advantageous therapeutic option for patients with mitral stenosis in terms of long-term outcomes. Unfavorable valve anatomy and persistent PH were the most important predictors of long-term outcomes. The persistence of PH is associated with the MVA obtained after PMV.