Repeat Percutaneous Mitral Balloon Valvuloplasty for Patients with Mitral Valve Restenosis

Objectives: To determine immediate and long-term clinical outcome, as well prognostic factors in patients who underwent repeat percutaneous mitral balloon valvuloplasty (PMBV). Background: Repeat PMBV may be a method of treatment for symptomatic patients with restenosis after successful initial PMBV, but data regarding its long term safety and efficacy are scarce. Methods: The study group consisted of 67 patients (mean age 52.1 +/- 10.5 years). All PMBV procedures were performed using the Inoue balloon system. Results: Repeat PMBV resulted in significant increase in MVA from 1.17 +/- 0.16 cm(2) to 1.63 +/- 0.22 cm(2) (P < 0.001). Good immediate result (MVA >= 1.5 cm(2), mitral regurgitation <= 2) was obtained in 52 (77.6%) patients and was not predicted by any analyzed factors. During follow-up (mean time 4.9 +/- 2.9 years) six patients died, nine underwent mitral valve replacement, four-third PMBV, and four developed heart failure. The 3-, 5-, and 8-year good functional results (survival free of mitral valve replacement, third PMBV or heart failure >= NYHA III) by Kaplan-Meier estimates were 89.3, 75.6, and 52.6%, respectively. These results were significantly superior in patients with good immediate results and echo score <7. In the entire population multivariate Cox regression analysis identified echo score <7 and absence of prior surgical commissurotomy as the independent predictors of event-free survival. Conclusions: Repeat PMBV is safe and provides good immediate results in patients with restenosis after successful first procedure. Long-term results of repeat PMBV are satisfactory and related mainly to the echo score and quality of the procedure. (C) 2010 Wiley-Liss, Inc.