Abstract 17495: Impact of Resting Pulmonary Hypertension on the Results of Percutaneous Mitral Balloon Valvuloplasty
Background: Resting pulmonary hypertension has been considered as an unfavorable condition for percutaneous mitral balloon valvuloplasty (PMV), but its impact on immediate and long-term outcome needs to be established.
Methods: Clinical data of a total of 429 consecutive patients with mitral stenosis who underwent PMV were reviewed. According to the maximal tricuspid jet velocity (TRVmax), patients were divided into 3 groups: group 1 (220 patients [51.2%] with TRVmax <3 m/s), group 2 (159 [37.1%] with 3<TRVmax<3.5 m/s) and group 3 (50 [11.7%] with TRVmax ≥3.5 m/s). Successful PMV was arbitrarily defined as mitral valve area (MVA) ≥1.8 cm2 with post-PMV mitral regurgitation <grade 3. Clinical event included mortality, mitral valve surgery and repeat intervention.
Results: Group 3 was characterized by younger age (48.3±10.7 versus 47.0±11.3 versus 41.1±10.0 years, p<0.001) and smaller MVA (1.09±0.19 versus 0.98±0.21 versus 0.85±0.21 cm2, p<0.001). PMV success rate was significantly lower in group 3 (69.9% in group 1, 62.9% in group 2 and 48% in group 3, p=0.012). Multivariate analysis showed that age (hazard ratio [HR] 1.02, 95% CI = 1.01-1.04, p=0.005), TRVmax (HR 1.75, 95% CI = 1.27 - 2.40, p=0.001) and echocardiographic score (HR 1.42, 95% CI = 1.23 - 1.65, p<0.001) were independently associated with successful PMV. Immediate results of PMV, rather than degree of resting pulmonary hypertension, determined the long-term event-free survival rate.
Conclusions: Resting pulmonary hypertension affects procedural success rate independently. Serious consideration is warranted to choose an optimal interventional strategy in this selected group of patients and every effort should be made to obtain a larger MVA as possible when PMV was chosen.
- © 2013 by American Heart Association, Inc.