PERCUTANEOUS MITRAL VALVULOTOMY WITH THE INOUE-BALLOON IN PATIENTS 65YEARS AND OLDER - ACUTE RESULTS AND SHORT-TERM FOLLOW-UP COMPARED TO YOUNGER PATIENTS

Percutaneous balloon mitral valvulotomy (PBMV) with the Inoue-balloon is a proven therapy in young patients with mitral stenosis. In this st udy, we investigated primary re suits in PBMV of elderly patients. In 383 patients with mitral stenosis PBMV was done with the Inoue-balloon . We compared primary success rates and short-term follow-up of 287 (7 4.9%) < 65-year-old patients and 96 (26.1%) greater than or equal to 6 5-year-old patients. Elderly patients were more likely to have atrial fibrillation (58% vs. 45%; p < 0.05), tricuspid regurgitation less tha n or equal to II degrees (58% vs. 45%; p < 0.05), coronary artery dis ease (16% vs. 6%; p < 0.01), and previous pulmonary edema (42% vs. 30% ; p < 0.05). PBMV was successful in 73.9% of the elderly and 84.7% of the younger patients (p < 0.05). Mitral valve gradients could be reduc ed from 12.5 +/- 11.6 mm Hg to 6.2 +/- 6.8 mm Hg (p < 0.001) in elderl y patients and from 15.5 +/- 6.9 mm Hg to 7.0 +/- 3.2 mm Hg (P < 0.001 ) in younger patients. Mitral valve areas increased from 1.0 +/- 0.3 c m(2) to 1.6 +/- 0.5 cm(2) (p < 0.001) in elderly patients and from 1.0 +/- 0.3 cm(2) to 1.7 +/- 0.4 cm(2) (p < 0.001) in younger patients. N o patient died during the procedure. Two younger patients had emergenc y surgery because of pericardial tamponade following transseptal punct ure. After PBMV elderly patients had more often an increase of mitral regurgitation (47% vs. 35%; p < 0.05) without need of an emergency mit ral valve replacement. During 3-month follow-up 6 elderly (6.3%) as we ll as 6 younger (2.1%) patients underwent elective mitral valve replac ement (p < 0.05). According to the NYHA classification elderly patient s had more complaints (1.9 +/- 0.8) than younger patients (1.6 +/- 0.6 ) (p < 0.001). In conclusion, PBMV with the Inoue-balloon is an effici ent therapy in elderly patients, too. Compared to younger patients pri mary success rate was reduced and incidence of mitral regurgitation wa s increased, probably because of the more severe changes of valvular a nd subvalvular morphology. Therefore, elderly patients more often unde rwent elective mitral valve replacement during short-term follow-up.