Intermediate outcomes of rheumatic mitral stenosis post-balloon mitral valvotomy

Abstract

Background Balloon mitral valvotomy is a standard therapeutic modality for managing rheumatic mitral stenosis. Data on intermediate outcomes of this procedure are limited. Thus we investigated the intermediate outcome after balloon mitral valvotomy performed at a large tertiary center in India. Methods Case records and follow-up data of 2330 patients who underwent valvotomy from June 1999 to December 2005 were retrieved from the hospital information system and analyzed. Results The median age of the patients was 32 ± 11 years, 1363 were female including 36 who were pregnant, and 379 were in atrial fibrillation. Follow-up ranged from 1 to 14 years (mean 4.5 years, median 4.0 years). The procedural success rate was 93%. Atrial fibrillation, higher functional class, and worse valve morphology were independent predictors of a poor procedural outcome. Patients with sinus rhythm had better event-free survival (10.43 years, 95% confidence interval: 10.1–10.7) compared to those with atrial fibrillation (8.17 years, 95% confidence interval: 7.5–8.8). Patients who achieved a valve area >1.75 cm2 had a better event-free survival (11.7 years, 95% confidence interval: 11.4–12.0) than those with a valve area of 1.5–1.74 cm2 (9.3 years, 95% confidence interval: 9.0–9.7). On multivariate analysis, higher functional class, worse valve morphology, and new significant mitral regurgitation were predictors of a poor outcome. Achieved mitral valve area >1.75 cm2 was an independent predictor of a good outcome. Conclusion Patients with sinus rhythm, less gross valve deformity, and a post-balloon mitral valvotomy area >1.75 cm2 had better intermediate outcomes.