Percutaneous transvenous mitral commissurotomy: In hospital and intermediate term follow up outcome from a prosepctive registry

Abstract Introduction Percutaneous Transvenous Mitral Commissurotomy (PTMC) is a minimally invasive procedure used to treat rheumatic mitral stenosis (MS). This study aims to evaluate in-hospital and short-term outcomes after discharge, and identify factors associated with poor procedural outcomes and short term restenosis. Methods This is a prospective single center registry of 232 patients with severe MS who underwent PTMC from January 2021 in our institution. Clinical and echocardiographic examinations done prior procedure, post procedure and 1 year post procedure and data were recorded. The primary outcome was immediate procedural success, while secondary outcome included all-cause mortality, need for mitral valve replacement (MVR), and restenosis at one year. Results A total of 232 patients were included in the study, with 34 males (14.6%) and 198 females (85.3%). The mean age was 34.29 ± 10.25 years. Successful outcome was observed in 67.7% (n = 157); suboptimal outcome: 21% (n = 51) and 10.3% (n = 24) had failed procedures as shown in Fig-1. Fig 2 shows the changes in the hemodynamic parameters immediate post procedure. There was a significant increase in mitral valve area and mitral valve separation index (MVSI) along with significant decrease in estimated pulmonary artery systolic pressure, trans-mitral gradients, mean left atrial pressures, left atrial diameter, and echocardiographic right ventricular dysfunction. There was a significant increase in number of patients with any mitral regurgitation (MR) post procedure was observed. 50 (21.6%) vs 202 (87%); P=0.005. Severe MR developed in 11 patients (4.7%), of whom five required in-hospital MVR. We observed that younger age, lower pre-PTMC MVA, presence of any MR, Right ventricular dysfunction and higher Wilkins score were associated with sub-optimal procedural outcome. 150 of the 232 patients had completed one year follow up period, of whom follow up details were available only for 133 (88.7%) patients. During the follow-up another five patients required MVR due to worsening MR. Of the 202 patients who had any MR post PTMC, only 95 (47%) patients has MR at one year follow up. At one year the all-cause mortality was 3% (7/232). Restenosis’ as defined by loss of ≥ 50% of the procedural gain, was observed in 9%. There was a significant decrease in MVA and MVSI over one year of follow up from 1.56 to 1.35 cm² (p = 0.000) and 8.48 to 7.29 (p = 0.001) respectively. Symptom worsening was observed in 20 patients, which was managed medically. There was a regression of estimated peak pulmonary artery systolic pressure from 103 to 74 mm of Hg over one year. Conclusion PTMC is a safe and effective treatment offering symptomatic relief and hemodynamic improvement, in with severe MS. Careful case selection is important to get good procedural outcome.