Selection of patients for percutaneous balloon mitral valvotomy: is there a definitive limit for the Wilkins score?
OBJECTIVE
The aim of this study was to determine the early and long-term results of percutaneous balloon mitral valvotomy (PBMV) in patients with Wilkins score (WS) between 9 and 11.


METHODS
We performed a retrospective review of clinical records of patients with rheumatic mitral stenosis who underwent PBMV between November 1991 and March 2008. Follow-up was obtained by telephone interview and/or clinical records. The procedure was considered unsuccessful when post-procedure mitral valve area was <1.5 cm(2).


RESULTS
We analyzed 124 patients, 108 (87.1%) of them women. Mean age at the time of repair was 46 ± 11 years and mean follow-up time was 10 ± 4 years. Before the procedure, 100 patients (80.6%) had WS ≤ 8 and 24 (19.4%) were in the "gray zone" (>8 and <11). Patients with WS ≤ 8 and patients in the gray zone had similar ages at first intervention (45 ± 11 vs. 49 ± 11 years; p=0.095) and follow-up time (10 ± 4 vs. 11 ± 5 years; p=0.55). There were no differences between groups in gender (women: 86% vs. 92%; p=0.735), or in baseline echocardiographic measurements (mitral valve area by planimetry 1.0 cm(2) [P25-P75: 0.9-1.1] vs. 0.9 [P25-P75: 0.8-1.2], p=0.514; pulmonary artery systolic pressure 53 mmHg [P25-P75: 45-63] vs. 50 [P25-P75: 44-54], p=0.823]; left atrial diameter >55 mm [16.5% vs. 13.6%, p=1.00]; mitral regurgitation [46.5% vs. 37.5%, p=0.428]) or baseline transmitral gradient (13 mmHg [P25-P75: 10-19] vs. 13 mmHg [P25-P75: 7-20]). Improvements in mitral valve area by planimetry and in hemodynamic gradient were similar in the two groups (0.91 ± 0.39 cm(2) vs. 0.84 ± 0.44 cm(2), p=0.55; 8.8 ± 5.3 mmHg vs. 7.3 ± 5.9 mmHg, p=0.275, respectively). There were no significant differences in major complications or success rates (4.0 vs. 12.5 p=0.131; 89.9% vs. 95.8%, p=0.69) or in need for urgent surgery or future reintervention (2.0 vs. 8.3%, p=0.168; 22% vs. 27.3%, p=0.594). In-hospital mortality occurred only in patients in the WS gray zone (2 [8.3%] vs. 0%, p=0.04), one death (4.2% vs. 0%, p=0.194) possibly being related to a higher WS (secondary to stroke) and the other as a consequence of peripheral vascular complication. Improvements in NYHA functional class soon after the procedure and during follow-up were similar in the two groups. Total mortality was similar in the two groups (3.1 vs. 8.7%, p=0.244).


CONCLUSIONS
PBMV was a safe and effective procedure in patients in the WS gray zone. Optimal results can be achieved in these patients if they are carefully selected and operated at experienced centers.
Serviço de Cardiologia, Centro Hospitalar de São João, Porto, Portugal. Electronic address: marianampaiva@gmail.com.
Mariana
M
Paiva
Ana Sofia
AS
Correia
Ricardo
R
Lopes
Alexandra
A
Gonçalves
Rui
R
Almeida
Pedro Bernardo
PB
Almeida
Cecília
C
Frutuoso
João Carlos
JC
Silva
Maria Júlia
MJ
Maciel
D063126:Balloon Valvuloplasty / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000145:classification* / Q000601:surgery*; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index
Estenose mitral; Mitral stenosis; Percutaneous balloon valvotomy; Score de Wilkins; Valvuloplastia percutânea mitral por balão; Wilkins score