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Songduang K, Kaolawanich Y, Karaketklang K, Ratanasit N. Incidence and predictors of adverse outcomes in patients with rheumatic mitral stenosis following percutaneous balloon mitral valvuloplasty: a study from a tertiary center in Thailand. BMC Cardiovasc Disord 2024; 24:391. [PMID: 39069638 DOI: 10.1186/s12872-024-04067-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Accepted: 07/22/2024] [Indexed: 07/30/2024] Open
Abstract
BACKGROUND Rheumatic mitral stenosis (MS) remains a common and concerning health problem in Asia. Percutaneous balloon mitral valvuloplasty (PBMV) is the standard treatment for patients with symptomatic severe MS and favorable valve morphology. However, studies on the incidence and predictors of adverse cardiac outcomes following PBMV in Asia have been limited. This study aims to evaluate the incidence and predictors of adverse outcomes in patients with rheumatic MS following PBMV. METHODS A retrospective cohort study was conducted on patients with symptomatic severe MS who underwent successful PBMV between 2002 and 2020 at a tertiary academic institute in Thailand. Patients were followed up to assess adverse outcomes, defined as a composite of cardiac death, heart failure hospitalization, repeat PBMV, or mitral valve surgery. Univariable and multivariable analyses were performed to identify predictors of adverse outcomes. A p-value of < 0.05 was considered statistically significant. RESULTS A total of 379 patients were included in the study (mean age 43 ± 11 years, 80% female). During a median follow-up of 5.9 years (IQR 1.7-11.7), 74 patients (19.5%) experienced adverse outcomes, with an annualized event rate of 2.7%. Multivariable analysis showed that age (hazard ratio [HR] 1.03, 95% confidence interval [CI] 1.008-1.05, p = 0.006), significant tricuspid regurgitation (HR 2.17, 95% CI 1.33-3.56, p = 0.002), immediate post-PBMV mitral valve area (HR 0.39, 95% CI 0.25-0.64, p = 0.01), and immediate post-PBMV mitral regurgitation (HR 1.91, 95% CI 1.18-3.07, p = 0.008) were independent predictors of adverse outcomes. CONCLUSIONS In patients with symptomatic severe rheumatic MS, the incidence of adverse outcomes following PBMV was 2.7% per year. Age, significant tricuspid regurgitation, immediate post-PBMV mitral valve area, and immediate post-PBMV mitral regurgitation were identified as independent predictors of these adverse outcomes.
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Affiliation(s)
- Kamonnart Songduang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Yodying Kaolawanich
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Khemajira Karaketklang
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, 10700, Thailand
| | - Nithima Ratanasit
- Division of Cardiology, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
- Her Majesty Cardiac Center, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand.
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Abdelghani M, Nunes MCP, Anwar AM, Prendergast B. Assessment of suitability for percutaneous mitral commissurotomy: a contemporary review of key anatomical criteria and predictive models. Eur Heart J Cardiovasc Imaging 2024; 25:739-753. [PMID: 38376989 DOI: 10.1093/ehjci/jeae052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2023] [Revised: 01/31/2024] [Accepted: 02/18/2024] [Indexed: 02/22/2024] Open
Abstract
The immediate result of percutaneous balloon mitral commissurotomy is largely determined by the anatomy of the mitral valve complex. Several scores and models have been developed to assess anatomical suitability for percutaneous balloon mitral commissurotomy. Although none has an optimal predictive power, these models look at the valvular apparatus from different perspectives bearing the potential for a complementary role.
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Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Cardiology Unit, Sohar Hospital, Muwelleh Street, 311 Sohar, Oman
- Cardiology Department, Amsterdam University Medical Center, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Maria Carmo P Nunes
- Hospital das Clinicas, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
| | - Ashraf M Anwar
- Cardiology Department, Al-Azhar University, Nasr City, 11651 Cairo, Egypt
- Department of Cardiology, King Fahad Armed Forces Hospital, Jeddah, Saudi Arabia
| | - Bernard Prendergast
- Department of Cardiology, Guys and St Thomas' NHS Foundation Trust Hospital London, London, UK
- Heart, Vascular & Thoracic Institute, Cleveland Clinic London, London, UK
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Abdelghani M, Metwally A, Samy M. Use of a deflectable ablation catheter to facilitate percutaneous mitral commissurotomy. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024:S1885-5857(24)00151-8. [PMID: 38729345 DOI: 10.1016/j.rec.2024.04.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/29/2024] [Indexed: 05/12/2024]
Affiliation(s)
- Mohammad Abdelghani
- Cardiology Department, Al-Azhar University, Cairo, Egypt; Cardiology Unit, Department of Internal Medicine, Sohar Hospital, Sohar, Oman; Faculty of Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | | | - Mohammed Samy
- Cardiology Department, Al-Azhar University, Cairo, Egypt
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Praz F, Beyersdorf F, Haugaa K, Prendergast B. Valvular heart disease: from mechanisms to management. Lancet 2024; 403:1576-1589. [PMID: 38554728 DOI: 10.1016/s0140-6736(23)02755-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 08/16/2023] [Accepted: 12/06/2023] [Indexed: 04/02/2024]
Abstract
Valvular heart disease is common and its prevalence is rapidly increasing worldwide. Effective medical therapies are insufficient and treatment was historically limited to the surgical techniques of valve repair or replacement, resulting in systematic underprovision of care to older patients and those with substantial comorbidities, frailty, or left ventricular dysfunction. Advances in imaging and surgical techniques over the past 20 years have transformed the management of valvular heart disease. Better understanding of the mechanisms and causes of disease and an increasingly extensive and robust evidence base provide a platform for the delivery of individualised treatment by multidisciplinary heart teams working within networks of diagnostic facilities and specialist heart valve centres. In this Series paper, we aim to provide an overview of the current and future management of valvular heart disease and propose treatment approaches based on an understanding of the underlying pathophysiology and the application of multidisciplinary treatment strategies to individual patients.
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Affiliation(s)
- Fabien Praz
- University Hospital Bern Inselspital, University of Bern, Bern, Switzerland.
| | - Friedhelm Beyersdorf
- Department of Cardiovascular Surgery, Heart Center, University of Freiburg, Freiburg, Germany; Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Kristina Haugaa
- Department of Cardiology, Oslo University Hospital, Rikshospitalet and University of Oslo, Oslo, Norway
| | - Bernard Prendergast
- Heart Vascular and Thoracic Institute, Cleveland Clinic London, London, UK; Department of Cardiology, St Thomas' Hospital, London, UK
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Giannini C, Mazzola M, Pugliese NR, Petronio AS. Mitral valve stenosis in the current era: a changing landscape. J Cardiovasc Med (Hagerstown) 2022; 23:701-709. [PMID: 36219149 DOI: 10.2459/jcm.0000000000001384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Mitral stenosis results from haemodynamic obstruction at the mitral valve level because of structural abnormalities of the valve apparatus, leading to increased resistance to the transmitral flow. Although rheumatic fever remains the predominant cause of mitral stenosis worldwide, other causes are increasingly relevant in the developed countries with degenerative mitral stenosis (DMS) because of mitral annulus calcification (MAC) becoming growingly prevalent in industrialized countries with higher life expectancy. Rheumatic mitral stenosis (RMS) and DMS display dramatic differences in pathophysiology, prognosis, and disease progression. Furthermore, to date, robust evidence regarding the management of DMS because of MAC is lacking. Nevertheless, new diagnostic techniques and catheter-based interventions are changing this landscape and paving the way to a significant reduction in DMS-related morbidity and mortality. Here we briefly review the current knowledge on the pathophysiology, diagnosis and treatment of DMS and RMS, underscoring the current diagnostic and therapeutic pathways, as well as persisting uncertainties and perspectives.
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Affiliation(s)
- Cristina Giannini
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana
| | - Matteo Mazzola
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana
| | | | - Anna Sonia Petronio
- Cardiac, Thoracic and Vascular Department, Azienda Ospedaliero-Universitaria Pisana
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Turi ZG. The 40th Anniversary of Percutaneous Balloon Valvuloplasty for Mitral Stenosis: Current Status. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100087. [PMID: 37288059 PMCID: PMC10242581 DOI: 10.1016/j.shj.2022.100087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 08/04/2022] [Accepted: 08/08/2022] [Indexed: 06/09/2023]
Abstract
Percutaneous balloon mitral valvuloplasty (PBMV), once the most complex of percutaneous cardiac procedures and essentially the first adult structural heart intervention, set the stage for a host of new technologies. Randomized studies comparing PBMV to surgery were the first to provide a high-level evidence base in structural heart. The devices used have changed little in 40 years, but the advent of improved imaging and the expertise gained in interventional cardiology has provided some additional procedural safety. However, with the decline in rheumatic heart disease, PBMV is being performed in fewer patients in industrialized nations; in turn, these patients have more comorbidities, less favorable anatomy, and thus a higher rate of procedure-related complications. There remain relatively few experienced operators, and the procedure is distinct enough from the rest of the structural heart intervention world that it has its own steep learning curve. This article reviews the use of PBMV in a variety of clinical settings, the influence of anatomic and physiologic factors on outcomes, the changes in the guidelines, and alternative approaches. PBMV remains the procedure of choice in patients with mitral stenosis with ideal anatomy and a useful tool in patients with less than ideal anatomy who are poor surgical candidates. In the 40 years since its first performance, PBMV has revolutionized the care of mitral stenosis patients in developing countries and remains an important option for suitable patients in industrialized nations.
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Affiliation(s)
- Zoltan G. Turi
- Address correspondence to: Zoltan G. Turi, MD, Structural and Congenital Heart Center, Hackensack University Medical Center, Hackensack Meridian School of Medicine, Hackensack, NJ 07601.
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Elkaryoni A, Hussain F, Chahine N, Khan R, Malhotra A, Mentias A, Alkhouli MA, Sharaf BL, Gordon P, Lopez JJ, Aronow HD, Abbott JD, Saad M. In-hospital and Readmission Outcomes With Percutaneous Balloon Mitral Valvuloplasty. Curr Probl Cardiol 2022; 47:101367. [PMID: 36007617 DOI: 10.1016/j.cpcardiol.2022.101367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 08/16/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Percutaneous balloon mitral valvuloplasty (PBMV) is primarily performed for rheumatic mitral stenosis (MS). Therefore, limited data exist on PBMV in countries with a low incidence of rheumatic disease. METHODS Using the Nationwide Readmission Database, we examined trends in in-hospital mortality and 30-day readmission among patients who received PBMV for rheumatic and non-rheumatic MS. We also examined the change in 90-day hospitalization rate before vs. after PBMV. RESULTS Between 2016 and 2019, there were 1109 hospitalizations in which patients received PBMV for rheumatic (n= 955, 86.1%) vs non-rheumatic MS (n=154, 13.9%). The all-cause in-hospital mortality for rheumatic and non-rheumatic MS did not change over time (0.9% → 2.0%, p=0.94, and 5.9% → 9.5%, p=0.09 respectively). Similarly, the 30-day readmission for patients with rheumatic and non-rheumatic MS did not change over time (12.4% → 9.9%, p=0.26, and 4.4% → 10.5%, p=0.30, respectively). The 90-day all-cause hospitalization rate remained the same before vs after PBMV for rheumatic and non-rheumatic MS (25.5% → 21.8%; p=0.14, and 24.0% → 33.7%; p=0.19, respectively). CONCLUSIONS Although no statistically significant change was noted over time for trends in in-hospital mortality, 30-day readmission, or even in the change in 90-day all-cause hospitalizations before and after PBMV for both types of MS, among those with non-rheumatic MS, there was a signal of an increase in the in-hospital mortality, and 30-day readmission, even more, there was 29% relative increase in 90-day hospitalizations after PBMV. Future studies are needed to examine the role of PBMV in patients with non-rheumatic MS.
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Affiliation(s)
- Ahmed Elkaryoni
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL.
| | - Fizza Hussain
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL
| | - Nicole Chahine
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL
| | - Rizwan Khan
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL
| | | | - Amgad Mentias
- Heart, Vascular and Thoracic Institute, Cleveland Clinic Foundation, Cleveland, OH
| | - Mohamad A Alkhouli
- Mayo Clinic College of Medicine and Science, Department of Cardiovascular Medicine, Rochester, MN
| | - Barry L Sharaf
- Lifespan Cardiovascular Institute, Providence, RI; Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Paul Gordon
- Lifespan Cardiovascular Institute, Providence, RI; Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI
| | - John J Lopez
- Division of Cardiovascular Disease, Loyola University Medical Center, Loyola Stritch School of Medicine, Maywood, IL
| | - Herbert D Aronow
- Lifespan Cardiovascular Institute, Providence, RI; Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI
| | - J Dawn Abbott
- Lifespan Cardiovascular Institute, Providence, RI; Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI
| | - Marwan Saad
- Lifespan Cardiovascular Institute, Providence, RI; Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, RI
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Rafael Sádaba J, Tribouilloy C, Wojakowski W. Guía ESC/EACTS 2021 sobre el diagnóstico y tratamiento de las valvulopatías. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2021.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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9
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. EUROINTERVENTION 2022; 17:e1126-e1196. [PMID: 34931612 PMCID: PMC9725093 DOI: 10.4244/eij-e-21-00009] [Citation(s) in RCA: 146] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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10
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur J Cardiothorac Surg 2021; 60:727-800. [PMID: 34453161 DOI: 10.1093/ejcts/ezab389] [Citation(s) in RCA: 314] [Impact Index Per Article: 104.7] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
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Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, Capodanno D, Conradi L, De Bonis M, De Paulis R, Delgado V, Freemantle N, Gilard M, Haugaa KH, Jeppsson A, Jüni P, Pierard L, Prendergast BD, Sádaba JR, Tribouilloy C, Wojakowski W. 2021 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J 2021; 43:561-632. [PMID: 34453165 DOI: 10.1093/eurheartj/ehab395] [Citation(s) in RCA: 2236] [Impact Index Per Article: 745.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
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Cormican DS, McHugh S, Sypert M, Shoubaki A, Boisen M, Ramakrishna H. Intervention for Asymptomatic Valvular Heart Disease: Analysis of Recent Data and Implications for the Perioperative Echocardiographer. J Cardiothorac Vasc Anesth 2021; 36:2196-2206. [PMID: 34247925 DOI: 10.1053/j.jvca.2021.05.054] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 05/28/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Daniel S Cormican
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA; Division of Critical Care Medicine, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Stephen McHugh
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Michael Sypert
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Ahmad Shoubaki
- Department of Anesthesiology, Allegheny Health Network, Pittsburgh, PA
| | - Michael Boisen
- Division of Cardiothoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, University of Pittsburgh Medical Center Shadyside, Pittsburgh, PA
| | - Harish Ramakrishna
- Division of Cardiovascular and Thoracic Anesthesiology, Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
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Tempe DK. Cardiac Anesthesiologist and Global Capacity Building to Tackle Rheumatic Heart Disease. J Cardiothorac Vasc Anesth 2021; 35:1922-1926. [PMID: 33637422 DOI: 10.1053/j.jvca.2021.01.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 01/27/2021] [Indexed: 11/11/2022]
Affiliation(s)
- Deepak K Tempe
- Visiting Professor, Institute of Liver and Biliary Sciences, New Delhi. Professor of Excellence and Former Dean, Maulana Azad Medical College, New Delhi, India.
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Baumgartner H, Iung B, Otto CM. Timing of intervention in asymptomatic patients with valvular heart disease. Eur Heart J 2020; 41:4349-4356. [DOI: 10.1093/eurheartj/ehaa485] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 04/08/2020] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
Abstract
Current management of valvular heart disease (VHD) seeks to optimize long-term outcome by timely intervention. Recommendations for treatment of patients with symptoms due to severe valvular disease are based on a foundation of solid evidence. However, when to intervene in asymptomatic patients remains controversial and decision requires careful individual weighing of the potential benefits against the risk of intervention and its long-term consequences. The primary rationale for earlier intervention is prevention of irreversible left ventricular (LV) myocardial changes that might result in later clinical symptoms and adverse cardiac events. A number of outcome predictors have been identified that facilitate decision-making. This review summarizes current recommendations and discusses recently published data that challenge them suggesting even earlier intervention. In adults with asymptomatic aortic stenosis (AS), emerging risk markers include very severe valve obstruction, elevated serum natriuretic peptide levels, and imaging evidence of myocardial fibrosis or increased extracellular myocardial volume. Currently, transcatheter aortic valve implantation (TAVI) is not recommended for treatment of asymptomatic severe AS although this may change in the future. In patients with aortic regurgitation (AR), the potential benefit of early intervention in preventing LV dilation and dysfunction must be balanced against the long-term risk of a prosthetic valve, a particular concern because severe AR often occurs in younger patients with a congenital bicuspid valve. In patients with mitral stenosis, the option of transcatheter mitral balloon valvotomy tilts the balance towards earlier intervention to prevent atrial fibrillation, embolic events, and pulmonary hypertension. When chronic severe mitral regurgitation is due to mitral valve prolapse, anatomic features consistent with a high likelihood of a successful and durable valve repair favour early intervention. The optimal timing of intervention in adults with VHD is a constantly changing threshold that depends not only on the severity of valve disease but also on the safety, efficacy, and long-term durability of our treatment options.
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Affiliation(s)
- Helmut Baumgartner
- Department of Cardiology III – Adult Congenital and Valvular Heart Disease, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149 Muenster, Germany
| | - Bernard Iung
- Cardiology Department, Bichat Hospital, APHP, Université de Paris, 46 Rue Henri Huchard, 75018 Paris, France
| | - Catherine M Otto
- Cardiology, University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195, USA
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Response to: The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries. Glob Heart 2020; 15:5. [PMID: 32489778 PMCID: PMC7218773 DOI: 10.5334/gh.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A response to Alcici et al., 2019 – thinking about how using conscious sedation for percutaneous mitral commissurotomy may improve outcomes in other areas.
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16
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Abstract
See Article Desnos et al
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Affiliation(s)
- Igor F Palacios
- 1 Massachusetts General Hospital Boston MA.,2 Harvard Medical School Boston MA
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Desnos C, Iung B, Himbert D, Ducrocq G, Urena M, Cormier B, Brochet E, Ou P, Vahanian A, Bouleti C. Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience. J Am Heart Assoc 2019; 8:e012031. [PMID: 31256703 PMCID: PMC6662374 DOI: 10.1161/jaha.119.012031] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background Percutaneous mitral commissurotomy (PMC) was the first available transcatheter technique for treatment of mitral valve diseases. Experience has led to extending the indications to patients with less favorable characteristics. We aimed to analyze (1) the temporal trends in characteristic and outcomes of patients undergoing PMC in a single center over 30 years and (2) the predictive factors of poor immediate results of PMC. Methods and Results From 1987 to 2016, 1 full year for each decade was analyzed: 1987, 1996, 2006, and 2016. Poor immediate results of PMC were defined as a mitral valve area <1.5 cm2 or MR (mitral regurgitation) grade >2. Mitral anatomy was assessed using the Cormier classification and the fluoroscopic extent of calcification. Six hundred three patients were included: 111, 202, 205, and 85, respectively. Mean age increased >10 years over time (P<0.0001). Mitral anatomy was less favorable over the years: the presence of calcification increased from 25% of patients at the beginning of PMC to >40% during the past decade (P<0.0001) with a 3‐fold increase in severe mitral calcification. Consistently, the proportion of good immediate results decreased over time (P<0.05) but remained at 76% in 2016. Multivariate analysis showed 3 predictive factors of poor immediate results: smaller baseline mitral valve area (P<0.0001), pre‐PMC MR grade 2 (P<0.01), and the presence or amount of calcification (P<0.001). Conclusions This clinic's patients became significantly older with more frequent and severe calcification in the past decade. Predictive factors of poor immediate results were related to valve anatomy, including calcification. Despite challenges raised by severe calcification, PMC was still successful in >3 out of 4 patients in recent years. See Editorial Palacios
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Affiliation(s)
- Cyrielle Desnos
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France
| | - Bernard Iung
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Dominique Himbert
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Grégory Ducrocq
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Marina Urena
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | | | - Eric Brochet
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France
| | - Phalla Ou
- 2 Department of Radiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Alec Vahanian
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
| | - Claire Bouleti
- 1 Department of Cardiology Bichat Hospital AP-HP Paris France.,3 DHU Fire Paris-Diderot University Sorbonne Paris Cité Paris France.,4 INSERM U1148 Bichat Hospital Paris France
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