Circulation, Vol 85, 2014-2024, Copyright © 1992 by American Heart Association
BACKGROUND. In response to the increasing use of percutaneous balloon
mitral commissurotomy, the National Heart, Lung, and Blood Institute
established the Balloon Valvuloplasty Registry in November 1987. METHODS
AND RESULTS. Between November 1, 1987, and October 31, 1989, 738 patients
aged 18 or older underwent percutaneous balloon mitral commissurotomy at
the clinical sites. Data were prospectively entered into the registry at
the time consent was obtained. Serious complications occurred in 87
procedures, or 12%. Death in the laboratory occurred in eight patients, or
1%. Within 30 days there were 24 cumulative deaths, 18 cardiac and six
noncardiac. Univariate analysis revealed that older age, a history of
cardiac arrest, cerebrovascular disease, dementia, renal insufficiency,
cachexia, class IV congestive heart failure, use of an intra-aortic balloon
pump, use of sympathomimetic amines, and a high echo score (greater than or
equal to 13) were associated with early death (p less than 0.01).
Additional univariate predictors included a precommissurotomy mitral valve
area of less than 0.7 cm2. Left atrial pressure greater than 12 mm Hg and a
mitral valve area of less than 1.5 cm2 after the procedure were also
associated with higher 30-day mortality (p less than 0.05). Multivariate
analysis identified higher echo score and smaller valve area before the
procedure as the strongest predictors of early death (p less than 0.001).
Centers that performed more than 25 procedures also had lower complication
rates. CONCLUSIONS. Although percutaneous balloon mitral commissurotomy
appears to be effective at relieving the hemodynamic effects of rheumatic
mitral stenosis, it does have risks. In properly selected patients,
however, it appears to have low morbidity and 30-day mortality. Individual
center experience with the procedure also appears to have great impact on
complications.
ARTICLES
Complications and mortality of percutaneous balloon mitral commissurotomy. A report from the National Heart, Lung, and Blood Institute Balloon Valvuloplasty Registry
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