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Outcomes of Severe Mitral Stenosis With the Revised Severity Criteria: Mitral Valve Replacement vs Percutaneous Mitral Valvuloplasty

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Author(s)
Dae-Young KimIksung ChoKyu KimSeo-Yeon GwakKyung Eun HaHee Jeong LeeKyu-Yong KoChi Young ShimJong-Won HaWilliam Dowon KimIn-Jai KimSeonhwa LeeIn-Cheol KimKang-Un ChoiHojeong KimJang-Won SonGeu-Ru Hong
Keimyung Author(s)
Kim, In Cheol
Department
Dept. of Internal Medicine (내과학)
Journal Title
Can J Cardiol
Issued Date
2023
Volume
40
Issue
1
Abstract
Background:
This study aimed to compare the outcomes, according to percutaneous mitral valvuloplasty (PMV) vs mitral valve replacement (MVR), of severe mitral stenosis (MS) with the updated criteria (MVA ≤ 1.5 cm2).

Methods:
From the Multicenter Mitral Stenosis With Rheumatic Etiology (MASTER) registry of 3140 patients, we included patients with severe MS who underwent PMV or MVR between January 2000 and December 2021 except for previous valvular surgery/intervention, at least moderate other valvular dysfunction, and thrombus at the left atrium/appendage. Moderately severe MS (MS-MS) and very severe MS (VS-MS) were defined as 1.0 cm2 < MVA ≤ 1.5 cm2 and MVA ≤ 1.0 cm2, respectively. Primary outcomes were a composite of cardiovascular (CV) death and heart failure (HF) hospitalization. Secondary outcomes were a composite of primary outcomes and redo intervention.

Results:
Among 442 patients (mean 56.5 ±11.9 years, women 77.1%), the MVR group (n = 260) was older, had more comorbidities, higher echoscore, larger left chambers, and higher right ventricular systolic pressure than the PMV group (n = 182). During a mean follow-up of 6.9 ± 5.2 years with inverse probability-weighted matching, primary outcomes did not differ, but the MVR group experienced fewer secondary outcomes (P = 0.010). In subgroup analysis of patients with MS-MS and VS-MS, primary outcomes did not differ. However, the MVR group in patients with VS-MS showed better secondary outcomes (P = 0.012).

Conclusions:
PMV or MVR did not influence CV mortality or HF hospitalization in both MS-MS and VS-MS. However, because of increased early redo intervention in the PMV group in VS-MS, MVR would be the preferable option without clear evidence of suitable morphology for PMV.
Keimyung Author(s)(Kor)
김인철
Publisher
School of Medicine (의과대학)
Type
Article
ISSN
1916-7075
Source
https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S0828282X23016598
DOI
10.1016/j.cjca.2023.09.006
URI
https://kumel.medlib.dsmc.or.kr/handle/2015.oak/45184
Appears in Collections:
1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
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