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Effect of Elevated Pulmonary Vascular Resistance on Outcomes After Percutaneous Mitral Valvuloplasty



Patients with mitral stenosis with severe pulmonary hypertension constitute a high-risk subset for surgical commissurotomy or valve replacement. The aim of the present study was to examine the effect of elevated pulmonary vascular resistance (PVR) on percutaneous mitral valvuloplasty (PMV) procedural success, short- and long-term clinical outcomes (i.e., mortality, mitral valve surgery, and redo PMV) in 926 patients. Of the 926 patients, 263 (28.4%) had PVR ≥4 Woods units (WU) and 663 (71.6%) had PVR <4 WU. Patients with PVR ≥4 WU were older and more symptomatic and had worse valve morphology for PMV. The patients with PVR ≥4 WU also had lower PMV procedural success than those with PVR <4 WU (78.2% vs 85.6%, p = 0.006). However, after multivariate adjustment, PVR was no longer an independent predictor of PMV success nor an independent predictor of the combined end point at a median follow-up of 3.2 years. In conclusion, elevated PVR at PMV is not an independent predictor of procedural success or long-term outcomes. Therefore, appropriately selected patients with rheumatic mitral stenosis might benefit from PMV, even in the presence of elevated preprocedural PVR.

 

Notes to editor


Ignacio Cruz-Gonzalez, Marc J. Semigram, Ignacio Inglessis-Azuaje, Maria Sanchez-Ledesma, Javier Martin-Moreiras, Hani Jneid, Pablo Rengifo-Moreno, Roberto J. Cubeddu, Andrew O. Maree, Pedro L. Sanchez, Igor F. Palacios
American journal of cardiology 2013;112(4),580-584

The content of this article reflects the personal opinion of the author/s and is not necessarily the official position of the European Society of Cardiology.