| Symptomatic mitral restenosis develops in up to 21% of patients after percutaneous balloon
mitral valvotomy (PBMV), and most of these patients undergo mitral valve replacement (MVR).
Hypothesis: Repeating PBMV (re-PBMV) might be an effective and less-invasive treatment for these patients.
Methods: Forty-seven patients with post-PBMV mitral restenosis and unfavorable valve characteristics were
assigned either to re-PBMV (25 cases; mean age 40.7 ± 11 y, 76% female) or MVR (22 cases; mean age
47 ± 10 y, 69% female) at 51 ± 33 months after the prior PBMV. The mean follow-up was 41 ± 32 months
and 63 ± 30 months for the re-PBMV and MVR groups, respectively.
Results: The 2 groups were homogenous in preoperative variables such as gender, echocardiographic findings,
and valve characteristics. Patients in theMVR groupwere older,with a higher mean New York Heart Association
functional class, mean mitral valve area, mitral regurgitation grade, and right ventricular systolic pressure
(P = 0.03), and more commonly were in AF. There were 3 in-hospital deaths (all in the MVR group) and 4
during follow-up (3 in the MVR group and 1 in the re-PBMV group). Ten-year survival was significantly higher
in re-PBMV vs MVR (96% vs 72.7%, P<0.05), but event-free survival was similar (52% vs 50%, P = 1.0) due
to high reintervention in the re-PBMV group (48% vs 18.1%, P = 0.02). |