Is redo percutaneous mitral balloon valvuloplasty (PMV) indicated in patients with post-PMV mitral restenosis?

OBJECTIVES The purpose of this study was to assess the immediate and long-t erm outcome of repeat percutaneous mitral balloon valvuloplasty (PMV) for p ost-PMV mitral restenosis. BACKGROUND Symptomatic mitral restenosis develop in 7% to 21% of patients a fter PMV. Currently, most of these patients are referred for mitral valve r eplacement. However, it is unknown if these patients may benefit from repea t PMV. METHODS We report the immediate outcome and long-term clinical follow-up re sults of 36 patients (mean age 58 +/- 13 years, 75% women) with symptomatic mitral restenosis after prior PMV, who were treated with a repeat PR-IV at 34.6 +/- 28 months after the initial PMV. The mean follow-up period was 30 +/- 33 months with a maximal follow-up of 10 years. RESULTS An immediate procedural success was obtained in 75% patients. The o verall survival rate was 74%, 72% and 71% at one, two, and three years resp ectively. The event-free survival rate was 61%, 54% and 47% at one, two, an d three years respectively. In the presence of comorbid diseases (cardiac a nd noncardiac) the two-year event-free survival was reduced to 29% as compa red with 86% in patients without comorbid diseases. Cox regression analysis identified the echocardiographic score (p = 0.03), post-PMV mitral valve a rea (p = 0.003), post-PMV mitral regurgitation grade (p = 0.02) and post-PM V pulmonary artery pressure (p = 0.0001) as independent predictors of event -free survival after repeat PMV. CONCLUSIONS Repeat PMV for post-PMV mitral restenosis results in good immed iate and long-term outcome in patients with low echocardiographic scores an d absence of comorbid diseases. Although the results are less favorable in patients with suboptimal characteristics, repeat PMV has a palliative role if the patients are not surgical candidates. (C) 1999 by the American Colle ge of Cardiology.