Percutaneous mitral commissurotomy in the elderly.
Immediate and mid-term results of percutaneous mitral commissurotomy (PMC) were assessed in 75 patients aged > or = 70 years (mean 75 +/- 4 (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<0.001). Three procedural deaths occurred (4%). Good initial results (valve area > or = 1.5 cm2 with mitral regurgitation < or = 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 +/- 18%; 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.
Iung
B
B
Cardiology Department, Tenon Hospital, Paris, France.
Cormier
B
B
Farah
B
B
Nallet
O
O
Porte
J M
JM
Michel
P L
PL
Vahanian
A
A
Acar
J
J
D000368:Aged; D002404:Catheterization; D003201:Computers; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D012189:Retrospective Studies