Author + information
- Claire Bouleti,
- Bernard Iung,
- Eric Brochet,
- David Messika–Zeitoun,
- Dominique Himbert,
- Eric Garbarz,
- Delphine Detaint,
- Bertrand Cormier and
- Alec Vahanian
Indications of percutaneous mitral commissurotomy (PMC) are debated in patients (pts) with calcified stenosis. We report outcome up to 20 years according to the presence and extent of valve calcification.
PMC was performed in 1024 consecutive pts between 1986 and 1995: 710 pts had non–calcified valves (NCAL group) and 314 had valve calcification (CAL group) graded from 1 (mild) to 4 (extensive). 177 pts (57%) were grade 1, 89 (28%) grade 2 and 48 (15%) grade 3 or 4.
Good immediate results (GIR) were obtained in 93% in NCAL group vs. 80% in CAL group (p<0.0001). Among CAL group, GIR were 87% for grade 1 calcification vs. 72% for grades 2,3 and 4 (p=0.01). Good functional results (GFR) were: survival without intervention and in NYHA class I or II. 20 year rates of GFR after GIR, were 40±3% in NCAL group vs. 21±3% in CAL group (p<0.0001). In CAL group, predictors of GFR after GIR were: younger age (p=0.003), lower NYHA class (p=0.01), sinus rhythm (p=0.0002), lower post–PMC mean gradient (p<0.0001) and lower extent of calcification (p=0.015). According to the extent of valve calcification, GFR were 35±4% for pts in grade 1 vs. 19±4% for pts in grades 2, 3 and 4 at 15 years (p=0.01).
Valve calcification has a negative impact on immediate and late results of PMC. However more than 1 out of 3 pts with mild calcification still benefits from PMC 15 years after GIR. PMC may be considered to defer surgery in selected pts with calcified valves, in particular young pts with few symptoms and in sinus rhythm.
Moderated Poster Contributions
Poster Sessions, Expo North
Monday, March 11, 2013, 9:45 a.m.–10:30 a.m.
Session Title: Valvular Heart Disease: Clinical VII – Mitral Valve
Abstract Category: 31. Valvular Heart Disease: Clinical
Presentation Number: 1285M–85
- 2013 American College of Cardiology Foundation