Repeat Percutaneous Balloon Mitral Valvotomy vs Mitral Valve Replacement in Patients With Restenosis After Previous Balloon Mitral Valvotomy and Unfavorable Valve Characteristics

Background: 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 the MVR group were 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). Conclusions: In a population with predominantly unfavorable characteristics for PBMV, short-and long-term outcomes are both reasonable after re-PBMV with less mortality but requiring more reinterventions compared with MVR.