Outcome of percutaneous mitral balloon valvuloplasty: comparison of the inoue and retrograde non-transseptal techniques. A single-center experience.
BACKGROUND
The transseptal Inoue (IN) and to a lesser extend retrograde non-transseptal (RNT) techniques are established procedures for percutaneous mitral balloon valvuloplasty (PBMV) in patients with mitral stenosis. However, a head to head comparison of these two techniques, especially from a single center, has not yet been reported.


METHODS
Seventy-two consecutive patients (n = 35 IN and n = 37 RNT) underwent PMBV in our clinic from October 1993 to December 1999. All baseline and procedural characteristics were compared, as well as immediate and long-term outcomes (mean follow-up, 42   12 months) of the patients.


RESULTS
Baseline characteristics were similar in the two groups. A successful immediate result was achieved in 91% of IN patients and 89% of RNT patients. After the PMBV, mitral valve area (MVA) increased from 1.04   0.16 cm2 to 1.6   0.3 cm2 and from 1.06   0.23 cm2 to 1.55   0.3 cm2 in the IN group and RNT group, respectively (p = NS). There was a higher percentage of mild mitral regurgitation (MR) after the RNT technique (p = 0.03). Mean fluoroscopy time was 31   16 minutes in the IN group and 39   11 minutes in the RNT group (p = 0.02). After discharge, major adverse cardiac events (MACE: mitral valve replacement, repeat PMBV) occurred in 3 patients (8%) patients in the IN group and 5 patients (13.5%) in the RNT group (p = NS). Follow-up echocardiographic evaluation revealed no significant changes regarding MVA in either group.


CONCLUSIONS
The IN and RNT techniques are comparable regarding the achieved MVA, with slightly more frequent MR post-RNT PBMV. IN requires significantly less fluoroscopy time. MACE and event-free survival rates at follow-up were similar in the two groups.
1st Cardiology Department, Onassis Cardiac Surgery Center, Athens, Greece. iako@hol.gr
Ioannis
I
Iakovou
Gregory
G
Pavlides
Vasilios
V
Voudris
George
G
Athanassopoulos
George
G
Karatasakis
Athanasios
A
Manginas
Vasilios
V
Vassilikos
George
G
Kourgiannidis
Emmanouel
E
Papadakis
Nikolaos
N
Koutsogiannis
George
G
Chatzigeorgiou
Dennis V
DV
Cokkinos
D000328:Adult; D002404:Catheterization; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006115:Greece; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology; D011183:Postoperative Complications / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome