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Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience
BACKGROUND: Percutaneous mitral commissurotomy (PMC) was the first available transcatheter technique for treatment of mitral valve diseases. Experience has led to extending the indications to patients with less favorable characteristics. We aimed to analyze (1) the temporal trends in characteristic...
Autores principales: | , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662374/ https://www.ncbi.nlm.nih.gov/pubmed/31256703 http://dx.doi.org/10.1161/JAHA.119.012031 |
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author | Desnos, Cyrielle Iung, Bernard Himbert, Dominique Ducrocq, Grégory Urena, Marina Cormier, Bertrand Brochet, Eric Ou, Phalla Vahanian, Alec Bouleti, Claire |
author_facet | Desnos, Cyrielle Iung, Bernard Himbert, Dominique Ducrocq, Grégory Urena, Marina Cormier, Bertrand Brochet, Eric Ou, Phalla Vahanian, Alec Bouleti, Claire |
author_sort | Desnos, Cyrielle |
collection | PubMed |
description | BACKGROUND: Percutaneous mitral commissurotomy (PMC) was the first available transcatheter technique for treatment of mitral valve diseases. Experience has led to extending the indications to patients with less favorable characteristics. We aimed to analyze (1) the temporal trends in characteristic and outcomes of patients undergoing PMC in a single center over 30 years and (2) the predictive factors of poor immediate results of PMC. METHODS AND RESULTS: From 1987 to 2016, 1 full year for each decade was analyzed: 1987, 1996, 2006, and 2016. Poor immediate results of PMC were defined as a mitral valve area <1.5 cm(2) or MR (mitral regurgitation) grade >2. Mitral anatomy was assessed using the Cormier classification and the fluoroscopic extent of calcification. Six hundred three patients were included: 111, 202, 205, and 85, respectively. Mean age increased >10 years over time (P<0.0001). Mitral anatomy was less favorable over the years: the presence of calcification increased from 25% of patients at the beginning of PMC to >40% during the past decade (P<0.0001) with a 3‐fold increase in severe mitral calcification. Consistently, the proportion of good immediate results decreased over time (P<0.05) but remained at 76% in 2016. Multivariate analysis showed 3 predictive factors of poor immediate results: smaller baseline mitral valve area (P<0.0001), pre‐PMC MR grade 2 (P<0.01), and the presence or amount of calcification (P<0.001). CONCLUSIONS: This clinic's patients became significantly older with more frequent and severe calcification in the past decade. Predictive factors of poor immediate results were related to valve anatomy, including calcification. Despite challenges raised by severe calcification, PMC was still successful in >3 out of 4 patients in recent years. |
format | Online Article Text |
id | pubmed-6662374 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-66623742019-08-02 Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience Desnos, Cyrielle Iung, Bernard Himbert, Dominique Ducrocq, Grégory Urena, Marina Cormier, Bertrand Brochet, Eric Ou, Phalla Vahanian, Alec Bouleti, Claire J Am Heart Assoc Original Research BACKGROUND: Percutaneous mitral commissurotomy (PMC) was the first available transcatheter technique for treatment of mitral valve diseases. Experience has led to extending the indications to patients with less favorable characteristics. We aimed to analyze (1) the temporal trends in characteristic and outcomes of patients undergoing PMC in a single center over 30 years and (2) the predictive factors of poor immediate results of PMC. METHODS AND RESULTS: From 1987 to 2016, 1 full year for each decade was analyzed: 1987, 1996, 2006, and 2016. Poor immediate results of PMC were defined as a mitral valve area <1.5 cm(2) or MR (mitral regurgitation) grade >2. Mitral anatomy was assessed using the Cormier classification and the fluoroscopic extent of calcification. Six hundred three patients were included: 111, 202, 205, and 85, respectively. Mean age increased >10 years over time (P<0.0001). Mitral anatomy was less favorable over the years: the presence of calcification increased from 25% of patients at the beginning of PMC to >40% during the past decade (P<0.0001) with a 3‐fold increase in severe mitral calcification. Consistently, the proportion of good immediate results decreased over time (P<0.05) but remained at 76% in 2016. Multivariate analysis showed 3 predictive factors of poor immediate results: smaller baseline mitral valve area (P<0.0001), pre‐PMC MR grade 2 (P<0.01), and the presence or amount of calcification (P<0.001). CONCLUSIONS: This clinic's patients became significantly older with more frequent and severe calcification in the past decade. Predictive factors of poor immediate results were related to valve anatomy, including calcification. Despite challenges raised by severe calcification, PMC was still successful in >3 out of 4 patients in recent years. John Wiley and Sons Inc. 2019-06-29 /pmc/articles/PMC6662374/ /pubmed/31256703 http://dx.doi.org/10.1161/JAHA.119.012031 Text en © 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Desnos, Cyrielle Iung, Bernard Himbert, Dominique Ducrocq, Grégory Urena, Marina Cormier, Bertrand Brochet, Eric Ou, Phalla Vahanian, Alec Bouleti, Claire Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience |
title | Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience |
title_full | Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience |
title_fullStr | Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience |
title_full_unstemmed | Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience |
title_short | Temporal Trends on Percutaneous Mitral Commissurotomy: 30 Years of Experience |
title_sort | temporal trends on percutaneous mitral commissurotomy: 30 years of experience |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6662374/ https://www.ncbi.nlm.nih.gov/pubmed/31256703 http://dx.doi.org/10.1161/JAHA.119.012031 |
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