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B. IUNG, B. CORMIER, B. FARAH, O. NALLET, J.-M. PORTE, P.-L. MICHEL, A. VAHANIAN, J. ACAR, Percutaneous mitral commissurotomy in the elderly, European Heart Journal, Volume 16, Issue 8, August 1995, Pages 1092–1099, https://doi.org/10.1093/oxfordjournals.eurheartj.a061052
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Abstract
Immediate and mid-term results of percutaneous mitral commissurotomy (PMC) were assessed in 75 patients aged ≥70 years (mean 75±4 years (70 to 86)). Co-morbidities were present in 30 patients (40%), and 58 patients had calcified valves (77%). Technical failure occurred in two patients. PMC was performed in 73 patients, using a single balloon in five, two balloons in 28, and the Inoue balloon in 42.
After PMC, valve area increased from 1⋅0±0⋅2 to 1⋅6±0⋅3 cm2 as assessed by 2D echo (P<0⋅0001). Three procedural deaths occurred (4%). Good initial results (valve area ≥1⋅5 cm2 with mitral regurgitation ≤214) were obtained in 48 patients (66%). In multivariate analysis, predictors of poor initial results were previous commissurotomy (P=0⋅01) and valve calcification (P=0⋅04).
Mean follow-up was 24±18 months. The 4-year actuarial results were: survival in 59±l8%; no need for operation in 59±18%; and persistent good functional results (NYHA class I or II) in 34±16%. The only predictor of mid-term good functional results was the quality of initial results (P<0⋅002). In conclusion, PMC in the elderly results in moderate but significant improvement in valve function at an acceptable risk: although subsequent functional deterioration is frequent. PMC is a useful although only palliative treatment in these patients.
