Mechanism and Immediate Outcome of Significant Mitral Regurgitation Following Balloon Mitral Valvuloplasty with JOMIVA Balloon

Surgical rescue mitral valve procedure post percutaneous transluminal mitral commissurotomy-a single-center observational study

Percutaneous transluminal mitral commissurotomy (PTMC) has become the standard of care for severe mitral stenosis with favorable anatomy. Although the complications have reduced over the years, the need for emergency surgical rescue persists. This study evaluates the outcomes of surgical rescue performed within 24 h of undergoing PTMC from 1 January 2013 to 31 December 2019. Out of 2259 PTMC patients, 22 patients (< 1%) required rescue mitral valve surgery. Out of 22 patients, 17 patients (77.27%) developed mitral regurgitation; five patients (22.7%) had cardiac tamponade. Mitral valve replacement was performed in 20 patients (90.9%), while two patients (9.1%) underwent mitral valve repair. Cardiac tamponade was secondary to injury of the left atrium (9.1%), left ventricle (4.5%), and right ventricle (9.1%). Concomitant tricuspid valve repair was done in three patients (13.6%). Intraoperatively, anterior mitral leaflet tear was seen in 68.2% while posterior mitral leaflet tear was noted in 9.1%. Postoperatively, three patients (13.6%) required prolonged ventilation, incidence of stroke was 4.5% (n = 1), and in-hospital mortality was 4.5% (n = 1). Intra-aortic balloon pump was used in three patients (13.6%), preoperatively. We conclude that post-PTMC complications are rare, but they require urgent surgical intervention.

Mitral Regurgitation After Percutaneous Mitral Valvuloplasty: Insights Into Mechanisms and Impact on Clinical Outcomes

OBJECTIVES

The aim of this study was to assess the incidence, mechanisms, and outcomes of mitral regurgitation (MR) after percutaneous mitral valvuloplasty (PMV).

BACKGROUND

Significant MR continues to be a major complication of PMV, with a wide range in clinical presentation and prognosis.

METHODS

Consecutive patients with mitral stenosis undergoing PMV were prospectively enrolled. MR severity was evaluated by using quantitative echocardiographic criteria, and its mechanism was characterized by 3-dimensional transesophageal echocardiography, divided broadly into 4 categories based on the features contributing to the valve damage. B-type natriuretic peptide levels were obtained before and 24 h after the procedure. Endpoints estimated cardiovascular death or mitral valve (MV) replacement due to predominant MR.

RESULTS

A total of 344 patients, ages 45.1 ± 12.1 years, of whom 293 (85%) were women, were enrolled. Significant MR after PMV was found in 64 patients (18.6%). The most frequent mechanism of MR was commissural, which occurred in 22 (34.4%) patients, followed by commissural with posterior leaflet in 16 (25.0%), leaflets at central scallop or subvalvular damage in 15 (23.4%), and central MR in 11 (17.2%). During the mean follow-up period of 3 years (range 1 day to 10.6 years), 60 patients reached the endpoint. The event-free survival rates were similar among patients with mild or commissural MR, whereas patients with damaged central leaflet scallop or subvalvular apparatus had the worst outcome, with an event-free survival rate at 1 year of only 7%. Long-term outcome was predicted by net atrioventricular compliance (C_n) at baseline and post-procedural variables, including valve area, mean gradient, and magnitude of decrease in B-type natriuretic peptide levels, adjusted for the mechanism of MR.

CONCLUSIONS

Significant MR following PMV is a frequent event, mainly related to commissural splitting, with favorable clinical outcome. Parameters that express the relief of valve obstruction and the mechanism by which MR develops were predictors of long-term outcomes.