Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty

Randomized comparison of Inoue and double-balloon techniques

Duk Hyun Kang, Seong Wook Park, Jae Kwan Song, Hyun Sook Kim, Myeongki Hong, Jae Joong Kim, Seung Jung Park

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

OBJECTIVES: The purpose of the present study was to compare the long- term clinical and echocardiographic results of the Inoue and the double- balloon techniques. BACKGROUND: The large randomized trial comparing the extent of commissurotomy and the long-term results between the double-balloon and Inoue balloon techniques has not been reported. METHODS: We conducted a prospective, randomized trial comparing two procedures in 302 consecutive patients who underwent percutaneous mitral valvuloplasty (PMV) using Inoue (n = 152; group I) or double-balloon technique (n = 150, group D) between 1989 and 1995. The sample size was planned to provide the study with approximately 80% power for the detection of a 10% difference between the two groups. RESULTS: There were no significant differences in baseline characteristics between the two groups. Immediately after PMV, mitral valve area (MVA) increased from 0.9 ± 0.2 to 1.8 ± 0.3 cm 2 in group I and from 0.9 ± 0.2 to 1.9 ± 0.3 cm 2 in group D. No significant differences existed between the two groups in terms of development of commissural splitting, commissural mitral regurgitation (CMR), moderate to severe mitral regurgitation (MR) and MVA after PMV. The successful immediate results (MVA ≥1.5 cm 2 and MR ≤2) were achieved in 127 (84%) patients of group I and 122 (81%) patients of group D (p = NS). Annual clinical and echocardiographic evaluation was completed for 290 (96%) patients with mean follow-up of 51 ± 27 months. Adverse events occurred in 19 (13%) patients of group I (3 deaths, 7 mitral valve replacements, 5 repeat PMV, 2 NYHA class ≥3, 2 technical failures) and 16 (11%) patients of group D (2 deaths, 10 mitral valve replacements, 3 repeat PMV, 1 NYHA class ≥3). Estimated actuarial seven-year event-free survival was 75 ± 7% in group I and 82 ± 6% in group D (p = NS). Estimated actuarial seven-year restenosis-free survival was 67 ± 7% in group I and 76 ± 6% in group D (p = NS). On multivariate analysis, unsuccessful immediate result (p < 0.001) and absence of CMR (p < 0.01) were independently related with events. Absence of CMR and smaller mitral valve area after PMV were independently related with restenosis (p < 0.001). CONCLUSIONS: The Inoue and double-balloon techniques were equally effective in commissurotomy and produced similar, excellent long-term results. The achievement of complete commissurotomy with development of CMR or larger post-PMV mitral valve area is important to optimize the long-term results of PMV.

Original languageEnglish
Pages (from-to)169-175
Number of pages7
JournalJournal of the American College of Cardiology
Volume35
Issue number1
DOIs
Publication statusPublished - 2000 Jan 1

Fingerprint

Mitral Valve
Mitral Valve Insufficiency
Sample Size
Disease-Free Survival
Multivariate Analysis
Survival

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Kang, Duk Hyun ; Park, Seong Wook ; Song, Jae Kwan ; Kim, Hyun Sook ; Hong, Myeongki ; Kim, Jae Joong ; Park, Seung Jung. / Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty : Randomized comparison of Inoue and double-balloon techniques. In: Journal of the American College of Cardiology. 2000 ; Vol. 35, No. 1. pp. 169-175.
@article{d6a26a4100b44beea9ea87b3e44caf50,
title = "Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty: Randomized comparison of Inoue and double-balloon techniques",
abstract = "OBJECTIVES: The purpose of the present study was to compare the long- term clinical and echocardiographic results of the Inoue and the double- balloon techniques. BACKGROUND: The large randomized trial comparing the extent of commissurotomy and the long-term results between the double-balloon and Inoue balloon techniques has not been reported. METHODS: We conducted a prospective, randomized trial comparing two procedures in 302 consecutive patients who underwent percutaneous mitral valvuloplasty (PMV) using Inoue (n = 152; group I) or double-balloon technique (n = 150, group D) between 1989 and 1995. The sample size was planned to provide the study with approximately 80{\%} power for the detection of a 10{\%} difference between the two groups. RESULTS: There were no significant differences in baseline characteristics between the two groups. Immediately after PMV, mitral valve area (MVA) increased from 0.9 ± 0.2 to 1.8 ± 0.3 cm 2 in group I and from 0.9 ± 0.2 to 1.9 ± 0.3 cm 2 in group D. No significant differences existed between the two groups in terms of development of commissural splitting, commissural mitral regurgitation (CMR), moderate to severe mitral regurgitation (MR) and MVA after PMV. The successful immediate results (MVA ≥1.5 cm 2 and MR ≤2) were achieved in 127 (84{\%}) patients of group I and 122 (81{\%}) patients of group D (p = NS). Annual clinical and echocardiographic evaluation was completed for 290 (96{\%}) patients with mean follow-up of 51 ± 27 months. Adverse events occurred in 19 (13{\%}) patients of group I (3 deaths, 7 mitral valve replacements, 5 repeat PMV, 2 NYHA class ≥3, 2 technical failures) and 16 (11{\%}) patients of group D (2 deaths, 10 mitral valve replacements, 3 repeat PMV, 1 NYHA class ≥3). Estimated actuarial seven-year event-free survival was 75 ± 7{\%} in group I and 82 ± 6{\%} in group D (p = NS). Estimated actuarial seven-year restenosis-free survival was 67 ± 7{\%} in group I and 76 ± 6{\%} in group D (p = NS). On multivariate analysis, unsuccessful immediate result (p < 0.001) and absence of CMR (p < 0.01) were independently related with events. Absence of CMR and smaller mitral valve area after PMV were independently related with restenosis (p < 0.001). CONCLUSIONS: The Inoue and double-balloon techniques were equally effective in commissurotomy and produced similar, excellent long-term results. The achievement of complete commissurotomy with development of CMR or larger post-PMV mitral valve area is important to optimize the long-term results of PMV.",
author = "Kang, {Duk Hyun} and Park, {Seong Wook} and Song, {Jae Kwan} and Kim, {Hyun Sook} and Myeongki Hong and Kim, {Jae Joong} and Park, {Seung Jung}",
year = "2000",
month = "1",
day = "1",
doi = "10.1016/S0735-1097(99)00502-1",
language = "English",
volume = "35",
pages = "169--175",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "1",

}

Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty : Randomized comparison of Inoue and double-balloon techniques. / Kang, Duk Hyun; Park, Seong Wook; Song, Jae Kwan; Kim, Hyun Sook; Hong, Myeongki; Kim, Jae Joong; Park, Seung Jung.

In: Journal of the American College of Cardiology, Vol. 35, No. 1, 01.01.2000, p. 169-175.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Long-term clinical and echocardiographic outcome of percutaneous mitral valvuloplasty

T2 - Randomized comparison of Inoue and double-balloon techniques

AU - Kang, Duk Hyun

AU - Park, Seong Wook

AU - Song, Jae Kwan

AU - Kim, Hyun Sook

AU - Hong, Myeongki

AU - Kim, Jae Joong

AU - Park, Seung Jung

PY - 2000/1/1

Y1 - 2000/1/1

N2 - OBJECTIVES: The purpose of the present study was to compare the long- term clinical and echocardiographic results of the Inoue and the double- balloon techniques. BACKGROUND: The large randomized trial comparing the extent of commissurotomy and the long-term results between the double-balloon and Inoue balloon techniques has not been reported. METHODS: We conducted a prospective, randomized trial comparing two procedures in 302 consecutive patients who underwent percutaneous mitral valvuloplasty (PMV) using Inoue (n = 152; group I) or double-balloon technique (n = 150, group D) between 1989 and 1995. The sample size was planned to provide the study with approximately 80% power for the detection of a 10% difference between the two groups. RESULTS: There were no significant differences in baseline characteristics between the two groups. Immediately after PMV, mitral valve area (MVA) increased from 0.9 ± 0.2 to 1.8 ± 0.3 cm 2 in group I and from 0.9 ± 0.2 to 1.9 ± 0.3 cm 2 in group D. No significant differences existed between the two groups in terms of development of commissural splitting, commissural mitral regurgitation (CMR), moderate to severe mitral regurgitation (MR) and MVA after PMV. The successful immediate results (MVA ≥1.5 cm 2 and MR ≤2) were achieved in 127 (84%) patients of group I and 122 (81%) patients of group D (p = NS). Annual clinical and echocardiographic evaluation was completed for 290 (96%) patients with mean follow-up of 51 ± 27 months. Adverse events occurred in 19 (13%) patients of group I (3 deaths, 7 mitral valve replacements, 5 repeat PMV, 2 NYHA class ≥3, 2 technical failures) and 16 (11%) patients of group D (2 deaths, 10 mitral valve replacements, 3 repeat PMV, 1 NYHA class ≥3). Estimated actuarial seven-year event-free survival was 75 ± 7% in group I and 82 ± 6% in group D (p = NS). Estimated actuarial seven-year restenosis-free survival was 67 ± 7% in group I and 76 ± 6% in group D (p = NS). On multivariate analysis, unsuccessful immediate result (p < 0.001) and absence of CMR (p < 0.01) were independently related with events. Absence of CMR and smaller mitral valve area after PMV were independently related with restenosis (p < 0.001). CONCLUSIONS: The Inoue and double-balloon techniques were equally effective in commissurotomy and produced similar, excellent long-term results. The achievement of complete commissurotomy with development of CMR or larger post-PMV mitral valve area is important to optimize the long-term results of PMV.

AB - OBJECTIVES: The purpose of the present study was to compare the long- term clinical and echocardiographic results of the Inoue and the double- balloon techniques. BACKGROUND: The large randomized trial comparing the extent of commissurotomy and the long-term results between the double-balloon and Inoue balloon techniques has not been reported. METHODS: We conducted a prospective, randomized trial comparing two procedures in 302 consecutive patients who underwent percutaneous mitral valvuloplasty (PMV) using Inoue (n = 152; group I) or double-balloon technique (n = 150, group D) between 1989 and 1995. The sample size was planned to provide the study with approximately 80% power for the detection of a 10% difference between the two groups. RESULTS: There were no significant differences in baseline characteristics between the two groups. Immediately after PMV, mitral valve area (MVA) increased from 0.9 ± 0.2 to 1.8 ± 0.3 cm 2 in group I and from 0.9 ± 0.2 to 1.9 ± 0.3 cm 2 in group D. No significant differences existed between the two groups in terms of development of commissural splitting, commissural mitral regurgitation (CMR), moderate to severe mitral regurgitation (MR) and MVA after PMV. The successful immediate results (MVA ≥1.5 cm 2 and MR ≤2) were achieved in 127 (84%) patients of group I and 122 (81%) patients of group D (p = NS). Annual clinical and echocardiographic evaluation was completed for 290 (96%) patients with mean follow-up of 51 ± 27 months. Adverse events occurred in 19 (13%) patients of group I (3 deaths, 7 mitral valve replacements, 5 repeat PMV, 2 NYHA class ≥3, 2 technical failures) and 16 (11%) patients of group D (2 deaths, 10 mitral valve replacements, 3 repeat PMV, 1 NYHA class ≥3). Estimated actuarial seven-year event-free survival was 75 ± 7% in group I and 82 ± 6% in group D (p = NS). Estimated actuarial seven-year restenosis-free survival was 67 ± 7% in group I and 76 ± 6% in group D (p = NS). On multivariate analysis, unsuccessful immediate result (p < 0.001) and absence of CMR (p < 0.01) were independently related with events. Absence of CMR and smaller mitral valve area after PMV were independently related with restenosis (p < 0.001). CONCLUSIONS: The Inoue and double-balloon techniques were equally effective in commissurotomy and produced similar, excellent long-term results. The achievement of complete commissurotomy with development of CMR or larger post-PMV mitral valve area is important to optimize the long-term results of PMV.

UR - http://www.scopus.com/inward/record.url?scp=0033978532&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033978532&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(99)00502-1

DO - 10.1016/S0735-1097(99)00502-1

M3 - Article

VL - 35

SP - 169

EP - 175

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 1

ER -