title: Predictors of Very Late Events After Percutaneous Mitral Valvuloplasty in Patients With Mitral Stenosis.
abstract: Data on long-term outcomes of percutaneous mitral valvuloplasty (PMV) are still scarce. In addition, the persistence of pulmonary hypertension (PH) after PMV is a complication for which mechanisms and prognostic implications are unclear. Our aims were (1) to report the long-term outcomes of patients with rheumatic mitral stenosis treated with PMV; (2) to determine the risk factors for long-term poor outcomes; and (3) to analyze the prevalence and predictors of persistent PH. We prospectively enrolled 532 patients who underwent PMV from 1987 to 2011 at 2 hospitals. The following end points were assessed after PMV: all-cause mortality, mitral reintervention, a composite end point of all-cause mortality and mitral reintervention, and PH persistence. Survival status was available for 97% patients; the median follow-up was 10 years (interquartile range 4 to 18 years). Procedural success was achieved in 85% patients. During the follow-up, 21% patients died and 27% required mitral reintervention. Before PMV, 74% patients had PH that persisted after PMV in 45% of patients (p <0.001). Unfavorable valve anatomy (Wilkins score >8) and post-PMV mean pulmonary arterial pressure (PAP) were independent predictors of all-cause mortality, mitral reintervention, and the composite end point. Post-PMV mean PAP was significantly correlated with a mitral valve area (MVA) <2.5 cm(2) (p <0.001); in addition, on the echocardiographic follow-up, MVA was an independent predictor of systolic PAP (p <0.001). In conclusion, PMV represents an advantageous therapeutic option for patients with mitral stenosis in terms of long-term outcomes. Unfavorable valve anatomy and persistent PH were the most important predictors of long-term outcomes. The persistence of PH is associated with the MVA obtained after PMV.
authors.affiliation: Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. Electronic address: elisabetejorge@gmail.com.
authors.forename: Elisabete
authors.initials: E
authors.lastname: Jorge
authors.affiliation: Department of Cardiology, Reina Sofia Hospital, University of Córdoba Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: Manuel
authors.initials: M
authors.lastname: Pan
authors.affiliation: Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Department of ​Thoracic and Vascular Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Rui
authors.initials: R
authors.lastname: Baptista
authors.affiliation: Department of Cardiology, Reina Sofia Hospital, University of Córdoba Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Romero
authors.affiliation: Department of Cardiology, Reina Sofia Hospital, University of Córdoba Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: Soledad
authors.initials: S
authors.lastname: Ojeda
authors.affiliation: Department of Cardiology, Reina Sofia Hospital, University of Córdoba Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Suárez de Lezo
authors.affiliation: Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Henrique
authors.initials: H
authors.lastname: Faria
authors.affiliation: Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: João
authors.initials: J
authors.lastname: Calisto
authors.affiliation: Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Department of ​Thoracic and Vascular Pathology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
authors.forename: Pedro
authors.initials: P
authors.lastname: Monteiro
authors.affiliation: Department of Cardiology, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
authors.forename: Mariano
authors.initials: M
authors.lastname: Pêgo
authors.affiliation: Department of Cardiology, Reina Sofia Hospital, University of Córdoba Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Cordoba, Spain.
authors.forename: José
authors.initials: J
authors.lastname: Suárez de Lezo
mesh_terms: D063126:Balloon Valvuloplasty / Q000379:methods*; D006328:Cardiac Catheterization / Q000379:methods*; D002423:Cause of Death / Q000639:trends; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000175:diagnosis* / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D011174:Portugal / Q000453:epidemiology; D011183:Postoperative Complications / Q000175:diagnosis* / Q000453:epidemiology; D011379:Prognosis; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome