Left atrial size predicts long-term outcome after balloon mitral valvuloplasty

BACKGROUND: The treatment of choice for severe rheumatic mitral stenosis is balloon mitral valvuloplasty(BMV). Numerous predictors of immediate and long-term procedural success have beendescribed. The aims of this study were to describe our experience with BMV over the last decade and toevaluate predictors of long-term event-free survival. METHODS: Medical records were retrospectively analyzed of patients who underwent BMV between2009 and 2021. The primary outcome was a composite endpoint of all-cause mortality, mitral valvereplacement (MVR), and repeat BMV. Long-term event-free survival was estimated using Kaplan-Meiercurves. Logistic regression was used to create a multivariate model to assess pre-procedural predictorsof the primary outcome. RESULTS: A total of 96 patients underwent BMV during the study period. The primary outcome occurredin 36 patients during 12-year follow-up: one (1%) patient underwent re-BMV, 28 (29%) underwentMVR, and eight (8%) died. Overall, event-free survival was 62% at 12 years. On multivariate analysis,pre-procedural left atrial volume index (LAVI) > 80 mL/m2 had a significant independent influenceon event-free survival, as did previous mitral valve procedure and systolic pulmonary arterial pressureabove 50 mmHg. CONCLUSIONS: Despite being a relatively low-volume center, excellent short and long-term results weredemonstrated, with event-free survival rates consistent with previous studies from high-volume centers.LAVI independently predicted long-term event-free survival.