Immediate Outcomes and Long-Term Follow-Up of Percutaneous Mitral Valvuloplasty

Ricardo Aquiles Sarmiento, Juan Gagliardi, Rodrigo Blanco, Gerardo Gigena, Jorge Lax, Jorge Szarfer, Alejandro Garcia Escudero, Federico Blanco, Roberto Neme, Miguel Angel Riccitelli

Abstract


Objetivos: Evaluar la eficacia la evolución clínica y ecocardiográfica inmediata y a largo plazo de la valvuloplastia mitral percutánea (VMP).

Métodos: se incluyeron 132 pacientes a los que se realizo VMP, con una mediana de seguimiento de 48 meses. Se consideró éxito primario cuando se obtuvo un área post-VMP ≥1,5 cm2. Se evaluó en el seguimiento: muerte, necesidad reemplazo valvular mitral (RMV) o de nueva VMP y reestenosis valvular.

Resultados: La media de edad fue de 44,6 años; sexo femenino: 88,5% (115 pacientes). La mediana del AVM pre-VMP era 0,90 cm² (IIC25-75: 0,81-1,00), la PAPs era de 44 mmHg (IIC25-75: 35-52) y el puntaje ecocardiográfico de 7 (IIC25-75: 6-9). Se obtuvo éxito primario en 104 pacientes (78,8%).

En el seguimiento a 4 años se encontraba asintomático el 86,5% de los pacientes (n=109). Se registraron 3 muertes intrahospitalarias (2,2%) y tres en el seguimiento (2,2%). Se realizó una nueva VMP en 10 pacientes y RVM en 4 pacientes.

Las variables asociadas a reestenosi en el seguimiento fueron el puntaje ecocardiográfico >8 (p= 0,04) y el AVM post VMP <1,8 cm2 (p=0,02). Luego del análisis multivariado, el AVM post-VMP <1,8 cm2 fue el único predictor de reestenosis (OR: 2,6; IC95%: 1,08-6,25).

Conclusiones. La VMP es segura y eficaz, cuya eficacia se mantiene a largo plazo; los mejores resultados inmediatos se obtienen en pacientes con puntaje ecocardiográfico bajo y en ritmo sinusal, mientras que aquellos que obtuvieron una mayor AVM pos-VMP, son los que presentan menor reestenosis en el seguimiento.


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Revista argentina de cardiología. ISSN en línea 1850-3748. Argentine journal of cardiology (English ed. Online ISSN 2314-2286) Sociedad Argentina de Cardiología. Azcuénaga 980 (C1115AAD),Ciudad Autónoma de Buenos Aires, República Argentina. Tel. (54 11) 4961-6027/8/9 Fax: 4961-6020 www.sac.org.ar revista@sac.org.ar