Long-term clinical and echocardiographic follow-up after percutaneous mitral valvuloplasty with the Inoue balloon

Background-The objective of this study was to assess the long-term clinical outcome and valvular changes (area and regurgitation) after percutaneous m itral valvuloplasty (PMV), Methods aad Results-After PMV, 561 patients were followed up for 39 (+/-23) months and clinical/echocardiographic data obtained yearly. Kaplan-Meier a nd Cox regression analyses were performed to estimate event-free survival, its predictors, and the relative risks of several patient subgroups. There were several nonexclusive events: 19 (3.3%) cardiac deaths, 55 (9.8%) mitra l replacements, 6 (1%) repeated PMVs, 56 (10%) cases of restenosis, and 108 (19%) cases of clinical impairment. Survival free of major events (cardiac death, mitral surgery, repeat PMV, or functional impairment) was 69% at 7 years, ranging from 88% to 40% in different subgroups of patients, Wilkins score was the best preprocedural predictor of mitral opening, but the proce dural result (mitral area and regurgitation) was the only independent predi ctor of major event-free survival. Mitral area loss, though mild [0.13 (+/- 0.21)cm(2)], increased with time and was greater than or equal to 0.3 cm(2) in 12%, 22%, and 27% of patients at 3, 5, and 7 years, respectively. Regur gitation did not progress in 81% of patients, and when it occurred it was u sually by I grade. Conclusions-Seven years after PMV, more than two thirds of patients were in good clinical condition and free of any major event. The procedural result was the main determinant of long-term outcome, although a high score had a lso negative implications. Mitral area decreased progressively over time, w hereas regurgitation did not tend to progress.