PERCUTANEOUS MITRAL COMMISSUROTOMY IN THE ELDERLY

Immediate and mid-term results of percutaneous mitral commissurotomy (PMC) were assessed in 75 patients aged greater than or equal to 70 years (mean 75 +/- 4 years (70 to 86)). Co-morbidities, were present in 30 patients (40%), and 58 patients had calcified valves (77%). Technical failure occurred in two patients. PMC was performed in 73 patients, using a single balloon in five, two balloons in 28, and the Inoue balloon in 42. After PMC, valve area increased from 1.0 +/- 0.2 to 1.6 +/- 0.3 cm(2) as assessed by 2D echo (P<0.0001). Three procedural deaths occurred (4%). Good initial results (valve area greater than or equal to 1.5 cm(2) with mitral regurgitation less than or equal to 2/4) were obtained in 48 patients (66%). In multivariate-analysis, predictors of poor initial results were previous commissurotomy (P=0.01) and valve calcification (P=0.04). Mean follow-up was 24 +/- 18 months. The 4-year actuarial results were: survival in 59 +/- 18%, no need for operation in 59 +/- 18%; and persistent good functional results (NYHA class I ol II) in 34 +/- 16%. The only predictor of mid-term good functional results was the quality, of initial results (P<0.002). In conclusion, PMC in the elderly results in moderate but significant improvement in valve function at an acceptable risk; although subsequent functional deterioration is frequent. PMC is a useful although only palliative treatment in these patients.