RETROGRADE NONTRANSSEPTAL BALLOON MITRAL VALVULOPLASTY - IMMEDIATE RESULTS AND INTERMEDIATE LONG-TERM OUTCOME IN 441 CASES - A MULTICENTER EXPERIENCE

Objectives. Our aim was to present the immediate and inter mediate lon g-term results of the application of retrograde non transseptal balloo n mitral valvuloplasty (RNBMV) in four cooperating centers from Greece and India, Background. RNBMV is a purely transarterial method of ball oon valvuloplasty, developed with the aim to avoid complications assoc iated with transseptal catheterization. Only single-center experience with RNBMV has been previously reported. Methods. The procedure was at tempted in 441 patients with symptomatic mitral stenosis (320 women, 1 21 men, mean age [+/- SD] 44 +/- 11 years, mean echocardiographic scor e [+/- SD] 7.7 +/- 2.0) from 1988 to 1996. Three hundred eighty-five p atients with successful immediate outcome were followed clinically for a mean [+/- SD] of 3.5 +/- 1.9 (range, 0.5-9.1) years. Results. A tec hnically successful procedure was achieved in 388 (88%) cases. The ech ocardiographic score (p < 0.001), male gender (p = 0.005), preprocedur al mitral regurgitation (p 0.007) and previous surgical commissurotomy (p = 0.029) were unfavorable predictors of immediate outcome. Complic ations included death (0.2%), severe mitral regurgitation (3.4%) and i njury of the femoral artery (1.1%), Event free (freedom from cardiac d eath, mitral valve surgery, repeat valvuloplasty and NYHA class > II s ymptoms) survival rates (+/- SEM) were 100%, 96.9 +/- 0.9%, 89.8 +/- 1 .9% and 75.5 +/- 5.5% at 1, 2, 4 and 9 years, respectively. The echoca rdiographic score (p < 0.001), NYHA class (p = 0.008) and postprocedur al mitral valve area (p = 0.009) mere significant independent predicto rs of intermediate long-term outcome. Conclusions. Multicenter experie nce indicates that RNBMV is a safe and effective technique for the tre atment of symptomatic mitral stenosis. As with the transseptal approac h, patients with favorable mitral valve anatomy derive the greatest im mediate and intermediate long-term benefit from this procedure. (C) 19 98 by the American College of Cardiology.