LONG-TERM OUTCOME IN ELDERLY PATIENTS AFTER BALLOON MITRAL VALVULOPASTY
L.A. Yates*, R.E. Peverill, R.W. Harper, J.J. Smolich.
Centre for Heart and Chest Research, Monash Medical Centre, and department of Medicine, Monash University, Clayton, Victoria.
While balloon mitral valvuloplasty (BMV) results in a smaller acute increase in mitral valve area in elderly patients with mitral stenosis, it is unclear whether this is associated with any reduction in the long-term symptomatic benefit of this procedure. To address this question, 132 patients who had undergone BMV by the Inoue method at Monash Medical Centre between 1989 and 1997 were divided into an elderly group aged >= 65 yrs (n = 27, 71±4 yrs, mean±SD) and a younger group aged <65 yrs (n = 105, 46±11 yrs) and compared with respect to haemodynamic, echocardiographic and demographic data. Follow-up was discontinued after attainment of any endpoint event, defined as mitral valve surgery, repeat BMV, NYHA class >= III or death. Median length of follow-up was 31 and 33 months respectively, with a maximum of 94 mths for both groups.
Elderly patients were more likely to have atrial fibrillation (p<0.001), coronary artery disease (p=0.002), and hypertension (p=0.004). Prior to BMV, elderly patients also had larger left atrial dimensions (p<0.005), a higher MGH echo score (p = 0.001) and a lower cardiac output (p<0.005). After BMV, elderly patients had a lesser increase in mitral valve area (p = 0.029). However, there was no significant difference in NYHA class between elderly and younger groups before or after BMV, nor in the percentage of patients who reported symptomatic benefit of BMV (85% vs 87%). Furthermore, there was no significant difference in the incidence of combined endpoints (26% vs 22%) or any individual event. Moreover, age >=65 yrs was not a predictor of the occurrence of an endpoint event.
Conclusion: Despite a greater likelihood of concomitant disease and a lesser increase in mitral valve area, elderly patients undergoing BMV have a similar symptomatic profile and long-term outcome when compared to younger patients.
