title: Effect of elevated pulmonary vascular resistance on outcomes after percutaneous mitral valvuloplasty.
abstract: Patients with mitral stenosis with severe pulmonary hypertension constitute a high-risk subset for surgical commissurotomy or valve replacement. The aim of the present study was to examine the effect of elevated pulmonary vascular resistance (PVR) on percutaneous mitral valvuloplasty (PMV) procedural success, short- and long-term clinical outcomes (i.e., mortality, mitral valve surgery, and redo PMV) in 926 patients. Of the 926 patients, 263 (28.4%) had PVR ≥4 Woods units (WU) and 663 (71.6%) had PVR <4 WU. Patients with PVR ≥4 WU were older and more symptomatic and had worse valve morphology for PMV. The patients with PVR ≥4 WU also had lower PMV procedural success than those with PVR <4 WU (78.2% vs 85.6%, p = 0.006). However, after multivariate adjustment, PVR was no longer an independent predictor of PMV success nor an independent predictor of the combined end point at a median follow-up of 3.2 years. In conclusion, elevated PVR at PMV is not an independent predictor of procedural success or long-term outcomes. Therefore, appropriately selected patients with rheumatic mitral stenosis might benefit from PMV, even in the presence of elevated preprocedural PVR.
authors.affiliation: Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. cruzgonzalez.ignacio@gmail.com
authors.forename: Ignacio
authors.initials: I
authors.lastname: Cruz-Gonzalez
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Semigram
authors.forename: Ignacio
authors.initials: I
authors.lastname: Inglessis-Azuaje
authors.forename: Maria
authors.initials: M
authors.lastname: Sanchez-Ledesma
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: Andrew O
authors.initials: AO
authors.lastname: Maree
authors.forename: Pedro L
authors.initials: PL
authors.lastname: Sanchez
authors.forename: Igor F
authors.initials: IF
authors.lastname: Palacios
mesh_terms: D016009:Chi-Square Distribution; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D006976:Hypertension, Pulmonary / Q000503:physiopathology*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D014655:Vascular Resistance