Mitral balloon valvotomy for the treatment of mitral stenosis in octogenarians

OBJECTIVES: To study the safety and benefit of mitral balloon valvotomy (MB V) in patients aged greater than or equal to 80 years. SETTING: A tertiary cardiac centre DESIGN: A retrospective study of 20 octogenarians (mean age 83, range 80-89 years) in whom percutaneous MBV was performed as a definitive or palliativ e treatment for severe mitral stenosis. All were in New York Heart Associat ion (NYHA) symptom class III or IV. Fourteen had been judged unfit for card iac surgery. Hemodynamic data was recorded before and after MBV. Symptomati c outcome was documented at 1 month for all patients. Outcome at 1 year was available for 16 patients. RESULTS: Dilatation of the mitral valve was achieved in all patients withou t major complications. Mean mitral valve area increased 106% from 0.81 (+/- 0.3) to 1.67 (+/- 0.8) cm(2), transvalvular gradient decreased from 11.8 ( +/- 4.8) to 5.6 (+/- 2.9) mm Hg, cardiac output increased from 3.1 (+/- 0.6 ) to 4.1 (+/- 1.4) l/min (all P < .01). Eight of these 20 patients obtained a valve area <greater than or equal to> 1.5 cm(2), and 16 obtained an area greater than or equal to 1.2 cm(2). One month after BMV, all patients were alive, and 16 of the 20 patients were improved by at least one NYHA class. This improvement was sustained in 7 of 16 patients followed up for 1 year. More severe mitral valve degenerative change, determined by echocardiograp hy, was associated with poorer outcome. CONCLUSIONS: In this group of very old and frail patients, MBV was safe and resulted in significant immediate improvement. Sustained symptomatic benef it at 1 year was obtained in those with less extensive leaflet and subvalvu lar disease. In patients with severe degenerative valve disease on echocard iography, but unacceptable surgical risk, MBV offers shortterm palliation.