Retrograde nontransseptal balloon mitral valvuloplasty: immediate results and intermediate long-term outcome in 441 cases—a multicenter experience

• Published in: Journal of the American College of Cardiology Vol. 32; no. 4; pp. 1009 - 1016
• Main Authors: Stefanadis, Christodoulos I, Stratos, Costas G, Lambrou, Spyros G, Bahl, Vinay Kumar, Cokkinos, Dennis V, Voudris, Vassilios A, Foussas, Stefanos G, Tsioufis, Costas P, Toutouzas, Pavlos K
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01-10-1998; Elsevier Science
• Subjects: Adult; Biological and medical sciences; Cardiac Catheterization; Catheterization - adverse effects; Catheterization - methods; Disease-Free Survival; Diseases of the cardiovascular system; Female; Follow-Up Studies; Humans; Male; Medical sciences; Middle Aged; Mitral Valve Stenosis - diagnostic imaging; Mitral Valve Stenosis - mortality; Mitral Valve Stenosis - therapy; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Ultrasonography; NYHA; LA; MR; MVR; RNBMV; MVA; LV; FA; FU; Human; Mitral valve; Prognosis; Treatment; Countercurrent; Follow up study; Instrumentation therapy; Cuffed tube; Surgical approach; Instrumental dilatation; Technique; Survival
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/S0735-1097(98)00357-X

Objectives. Our aim was to present the immediate and intermediate long-term results of the application of retrograde nontransseptal balloon mitral valvuloplasty (RNBMV) in four cooperating centers from Greece and India.
Background. RNBMV is a purely transarterial method of balloon valvuloplasty, developed with the aim to avoid complications associated with transseptal catheterization. Only single-center experience with RNBMV has been previously reported.
Methods. The procedure was attempted in 441 patients with symptomatic mitral stenosis (320 women, 121 men, mean age [± SD] 44 ± 11 years, mean echocardiographic score [± SD] 7.7 ± 2.0) from 1988 to 1996. Three hundred eighty-five patients with successful immediate outcome were followed clinically for a mean [± SD] of 3.5 ± 1.9 (range, 0.5–9.1) years.
Results. A technically successful procedure was achieved in 388 (88%) cases. The echocardiographic score (p < 0.001), male gender (p = 0.005), preprocedural mitral regurgitation (p = 0.007) and previous surgical commissurotomy (p = 0.029) were unfavorable predictors of immediate outcome. Complications included death (0.2%), severe mitral regurgitation (3.4%) and injury of the femoral artery (1.1%). Event-free (freedom from cardiac death, mitral valve surgery, repeat valvuloplasty and NYHA class > II symptoms) survival rates (± SEM) were 100%, 96.9 ± 0.9%, 89.8 ± 1.9% and 75.5 ± 5.5% at 1, 2, 4 and 9 years, respectively. The echocardiographic score (p < 0.001), NYHA class (p = 0.008) and postprocedural mitral valve area (p = 0.009) were significant independent predictors of intermediate long-term outcome.
Conclusions. Multicenter experience indicates that RNBMV is a safe and effective technique for the treatment of symptomatic mitral stenosis. As with the transseptal approach, patients with favorable mitral valve anatomy derive the greatest immediate and intermediate long-term benefit from this procedure.