title: Percutaneous mitral valvuloplasty in surgical high risk patients.
abstract: Among 126 consecutive patients undergoing percutaneous mitral valvuloplasty, 34 were judged to be at high risk for surgery on the basis of age greater than 70 years (n = 13), New York Heart Association functional class IV (n = 11), ejection fraction less than or equal to 35% (n = 3), severe pulmonary hypertension (n = 7), need for associated coronary bypass (n = 4) or additional valve surgery (n = 20) or severe pulmonary disease (n = 3). Baseline features of the high risk group were substantially worse than those of the other patients: age (65 +/- 11 versus 49 +/- 12 years; p = 0.0001) and echocardiographic score (9.4 +/- 1.8 versus 8.2 +/- 1.5; p = 0.005) were higher, whereas cardiac output (2.9 +/- 0.9 versus 4.1 +/- 1.2 liters/min; p = 0.0001) and mitral valve area (0.9 +/- 0.4 versus 1.1 +/- 0.3 mm2; p = 0.002) were lower. Three high risk patients experienced technical failures and three others had major complications. Among the remaining 28 patients, 18 (65%) had a complete hemodynamic success, 4 (14%) an incomplete success and 6 (21%) hemodynamic failure. Stepwise logistic regression analysis retained echocardiographic score as the only factor independently predictive of success. The percent increase in mitral valve area also correlated with echocardiographic score (r = 0.51, p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
authors.affiliation: Department of Medicine, Montreal Heart Institute, Quebec, Canada.
authors.forename: T
authors.initials: T
authors.lastname: Lefèvre
authors.forename: R
authors.initials: R
authors.lastname: Bonan
authors.forename: A
authors.initials: A
authors.lastname: Serra
authors.forename: J
authors.initials: J
authors.lastname: Crépeau
authors.forename: I
authors.initials: I
authors.lastname: Dyrda
authors.forename: R
authors.initials: R
authors.lastname: Petitclerc
authors.forename: Y
authors.initials: Y
authors.lastname: Leclerc
authors.forename: O
authors.initials: O
authors.lastname: Vanderperren
authors.forename: D
authors.initials: D
authors.lastname: Waters
mesh_terms: D000368:Aged; D002404:Catheterization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D012044:Regression Analysis; D012307:Risk Factors; D013997:Time Factors