Impact of commissural calcification on clinical outcome of percutaneous balloon mitral valvuloplasty; a retrospective cohort study of 876 patients. - 2024

Available online from MWHC library: 2001 - present

BACKGROUND: Percutaneous balloon mitral valvuloplasty (PBMV) is the ACC/AHA class I recommendation for treating symptomatic rheumatic mitral stenosis with suitable valve morphology, less than moderate MR and absence of left atrium clot. The mitral valve restenosis and significant mitral regurgitation (MR) are known adverse outcomes of PBMV. This study aimed to evaluate the outcomes of PBMV in patients with severe mitral stenosis and the effect of Commissural Calcification (CC) on the outcomes. CONCLUSION: Commissural calcification (CC) is an independent predictor of the significant symptomatic MR (an important determinant of adverse outcome) following PBMV in the early and mid-term follow-up. Mitral valve restenosis occurs more in patients with higher Wilkins score compared to group I with score <= 8. Combined Wilkins score and CC should be considered for patient suitability for PBMV. Copyright © 2024. The Author(s). METHODS: In this single-center retrospective cohort study, 876 patients who underwent PBMV were categorized into three groups based on their Wilkins score (Group I: score <= 8, Group II: score 9-10, and Group III: score 11-12). Patients were evaluated before, early after PBMV and at 6- and 24-month follow-ups. Main clinical outcomes were defined as significant restenosis and or symptomatic significant MR (moderate to severe and severe MR) or candidate for mitral valve replacement (MVR). The outcomes were compared between patients with and without CC. RESULTS: A total of 876 patients with mean age 46.4 +/- 12.3 years (81.0% females) were categorized based on Wilkins score. 333 (38.0%) were in Group I, 501 (57.2%) were in Group II, and 42 (4.8%) were in Group III. CC was present in 175 (20.0%) of the patients, among whom 95 (54.3%) had calcification of the anterolateral commissure, 64 (36.6%) had calcification of the posteromedial commissure, and in 16 (9.1%) patients both commissures were calcified. There was a significant difference in Wilkins score between patients with and without CC (P < 0.001). CC was associated with higher odds of significant symptomatic MR at early and mid-term follow up (OR: 1.69, 95%CI 1.19-2.41, P = 0.003; and OR: 3.90, 95%CI 2.61-5.83, P < 0.001, respectively), but not with restenosis (P = 0.128). Wilkins Groups II and III did not show higher odds of significant symptomatic MR compared to Group I at early (II: P = 0.784; III: P = 0.098) and mid-term follow up (II: P = 0.216; III: P = 0.227). Patients in Wilkins Group II had higher odds of restenosis compared to Group I (OR: 2.96,95%CI: 1.35-6.27, P = 0.007).


English

1471-2261

10.1186/s12872-024-03932-w [pii] PMC11184739 [pmc]


*Balloon Valvuloplasty
*Calcinosis
*Mitral Valve
*Mitral Valve Insufficiency
*Mitral Valve Stenosis
*Severity of Illness Index
Adult
Balloon Valvuloplasty/ae [Adverse Effects]
Calcinosis/dg [Diagnostic Imaging]
Calcinosis/th [Therapy]
Female
Humans
Male
Middle Aged
Mitral Valve Insufficiency/dg [Diagnostic Imaging]
Mitral Valve Insufficiency/et [Etiology]
Mitral Valve Insufficiency/pp [Physiopathology]
Mitral Valve Insufficiency/su [Surgery]
Mitral Valve Insufficiency/th [Therapy]
Mitral Valve Stenosis/dg [Diagnostic Imaging]
Mitral Valve Stenosis/pp [Physiopathology]
Mitral Valve Stenosis/su [Surgery]
Mitral Valve Stenosis/th [Therapy]
Mitral Valve/dg [Diagnostic Imaging]
Mitral Valve/pp [Physiopathology]
Mitral Valve/su [Surgery]
Recovery of Function
Recurrence
Retrospective Studies
Rheumatic Heart Disease/co [Complications]
Rheumatic Heart Disease/dg [Diagnostic Imaging]
Rheumatic Heart Disease/pp [Physiopathology]
Rheumatic Heart Disease/th [Therapy]
Risk Factors
Time Factors
Treatment Outcome--Automated


MedStar Health Research Institute


Journal Article