title: Impact of concomitant aortic regurgitation on percutaneous mitral valvuloplasty: Immediate results, short-term, and long-term outcome.
abstract: BACKGROUND
  The aim of the study is to examine the effect of concomitant aortic regurgitation (AR) on percutaneous mitral valvuloplasty (PMV) procedural success, short-term, and long-term clinical outcome. No large-scale study has explored the impact of coexistent AR on PMV procedural success and outcome.
  
  
  METHODS
  Demographic, echocardiographic, and procedure-related variables were recorded in 644 consecutive patients undergoing 676 PMV at a single center. Mortality, aortic valve surgery (replacement or repair) (AVR), mitral valve surgery (MVR), and redo PMV were recorded during follow-up.
  
  
  RESULTS
  Of the 676 procedures performed, 361 (53.4%) had no AR, 287 (42.5%) mild AR, and 28 (4.1%) moderate AR. There were no differences between groups in the preprocedure characteristics, procedural success, or in the incidence of inhospital adverse events. At a median follow-up of 4.11 years, there was no difference in the overall survival rate (P = .22), MVR rate (P = .69), or redo PMV incidence (P = .33). The rate of AVR was higher in the moderate AR group (0.9% vs 1.9% vs 13%, P = .003). Mean time to AVR was 4.5 years and did not differ significantly between patients with no AR, mild AR, or moderate AR (2.9 +/- 2.1 vs 5.7 +/- 3.6 vs 4.1 +/- 2.5 years, P = .46).
  
  
  CONCLUSIONS
  Concomitant AR at the time of PMV does not influence procedural success and is not associated with inferior outcome. A minority of patients with MS and moderate AR who undergo PMV will require subsequent AVR on long-term follow-up. Thus, patients with rheumatic MS and mild to moderate AR remain good candidates for PMV.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
authors.forename: Maria
authors.initials: M
authors.lastname: Sanchez-Ledesma
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sanchez
authors.forename: Javier
authors.initials: J
authors.lastname: Martin-Moreiras
authors.forename: Hani
authors.initials: H
authors.lastname: Jneid
authors.forename: Pablo
authors.initials: P
authors.lastname: Rengifo-Moreno
authors.forename: Roberto J
authors.initials: RJ
authors.lastname: Cubeddu
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis
authors.forename: Andrew O
authors.initials: AO
authors.lastname: Maree
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D001022:Aortic Valve Insufficiency / Q000150:complications*; D002305:Cardiac Tamponade / Q000209:etiology; D002404:Catheterization / Q000009:adverse effects; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000150:complications / Q000401:mortality / Q000628:therapy*; D012189:Retrospective Studies; D012214:Rheumatic Heart Disease / Q000628:therapy*; D015996:Survival Rate; D016896:Treatment Outcome