title: Long-term results (up to 16.5 years) of mitral balloon valvuloplasty in a series of 518 patients and predictors of long-term outcome.
abstract: OBJECTIVE
  To assess the long-term results (up to 16.5 years) of mitral balloon valvuloplasty (MBV) and to identify predictors of restenosis and event-free survival.
  
  
  RESULTS
  We report the immediate and long-term clinical and echocardiographic results in 518 patients, mean age 31 +/- 11 years, who underwent successful MBV for severe mitral stenosis (MS) and were followed up for 0.5-16.5 (mean 6 +/- 4.5) years. After MBV, mitral valve area (MVA) increased from 0.84 +/- 0.2 to 1.83 +/- 0.53 cm(2) (P < 0.0001) as measured by catheter and from 0.92 +/- 0.17 to 1.96 +/- 0.29 cm(2) (P < 0.0001) as measured by two-dimensional echo. Restenosis occurred in 111 patients (21%) and it was less frequent in patients with low echo score (11%). Actuarial freedom from restenosis at 5, 10, 15 years was 85 +/- 1%, 70 +/- 3%, and 44 +/- 5%, respectively, and was significantly higher in patients with low echo score. Event-free survival (death, redo MBV, mitral valve replacement, New York Heart Association [NYHA] functional class III or IV) at 5, 10, 15 years was 89 +/- 1%, 79 +/- 2%, 43 +/- 9%, respectively, and was significantly higher for patients with low echo score. Cox regression analysis identified mitral echocardiographic score (MES) > 8 (P < 0.0001), postprocedure mitral valve area (MVA) (P = 0.0015), and preprocedure functional class (P = 0.014) as predictors of restenosis and MES (P < 0.0001) and age (P < 0.0001) and postprocedure MVA (P = 0.015) as predictors of event-free survival.
  
  
  CONCLUSIONS
  MBV provides excellent long-term results for selected patients with MS. The long-term outcome after this procedure can be predicted from baseline clinical and echocardiographic characteristics.
authors.affiliation: King Faisal Heart Institute (MBC 16), King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. fawzy100@hotmail.com
authors.forename: Mohamed E
authors.initials: ME
authors.lastname: Fawzy
authors.forename: Bahaa
authors.initials: B
authors.lastname: Fadel
authors.forename: Hani
authors.initials: H
authors.lastname: Al-Sergani
authors.forename: Mohammed
authors.initials: M
authors.lastname: Al Amri
authors.forename: Walid
authors.initials: W
authors.lastname: Hassan
authors.forename: Khalid
authors.initials: K
authors.lastname: Abdulbaki
authors.forename: Mohamed
authors.initials: M
authors.lastname: Shoukri
authors.forename: Charles
authors.initials: C
authors.lastname: Canver
mesh_terms: D000328:Adult; D002404:Catheterization; D018572:Disease-Free Survival; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D011183:Postoperative Complications; D016016:Proportional Hazards Models; D012008:Recurrence; D012529:Saudi Arabia; D012720:Severity of Illness Index; D016019:Survival Analysis; D016896:Treatment Outcome