ISSN 2149-2263 | E-ISSN 2149-2271
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Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score? [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(5): 373-379 | DOI: 10.5152/akd.2014.5466

Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score?

Muhammad Tariq Farman1, Naveedullah Khan2, Jawaid Akbar Sial3, Tahir Saghir2, Tariq Ashraf2, Syed Ishtiaq Rasool2, Khan Shah Zaman2
1Jinnah Medical College Hospital; Karachi-Pakistan
2National Institute of Cardiovascular Diseases; Karachi-Pakistan
3Chandka Medical College Hospital; Larkana-Pakistan

Objective: To know the predictors of a successful outcome of percutaneous transvenous mitral commissurotomy (PTMC) other than described in the Wilkins scoring system.

 
Methods: Two hundred fifty-eight consecutive patients were enrolled for this observational study in a tertiary care heart center of Pakistan who had a Wilkins score of ?8. Patients with more than mild mitral regurgitation (MR) or having a clot in the left atrium were excluded. The Bonhoeffer multi-track system was used as a default technique. Successful PTMC was defined as achieving a mitral valve area (MVA) of ?1.5 cm2 with no more than mild MR.
 
Results: Out of 258 PTMC procedures, 197 were successful. The Bonhoeffer multi-track system was used in ~94% cases. Among unsuccessful procedures, 41 patients did not achieve the required valve area, and 21 patients developed more than mild MR, including those 8 patients who did not achieve the required valve area and had more than mild MR. Bigger mean annulus size (33.5±2.6 versus 32.8±2.1 mm; p=0.02) and preprocedure MVA (0.93±0.1 versus 0.87±0.1 cm2; p=0.002) had a significant effect on successful PTMC. Lower mean preprocedure systolic right ventricular pressure on echo (65.4±19.4 versus 75.3±18 mm Hg; p=0.000) and on cath (74±21.5 versus 81.5±24.6 mm Hg; p=0.002), lower grade of left ventricular dysfunction (p=0.04), and tricuspid regurgitation on echo (p=0.003) also had positive effects on the outcome.
 
Conclusion: Bigger preprocedure mitral valve annulus size and mitral valve area, and better left and right ventricular hemodynamics are correlated with successful PTMC. 
 

Keywords: percutaneous transvenous mitral commissurotomy, Bonhoeffer multi-track system, predictors

Orta veya şiddetli mitral darlığı olan hastalarda Bonhoeffer Multi-Track sistemi kullanılarak başarılı perkütan transvenöz mitral komissürotominin prediktörleri- Wilkin skoru ötesinde görebilir miyiz?

Muhammad Tariq Farman1, Naveedullah Khan2, Jawaid Akbar Sial3, Tahir Saghir2, Tariq Ashraf2, Syed Ishtiaq Rasool2, Khan Shah Zaman2
1Jinnah Medical College Hospital; Karachi-Pakistan
2National Institute of Cardiovascular Diseases; Karachi-Pakistan
3Chandka Medical College Hospital; Larkana-Pakistan

Amaç: Wilkin skorlama sisteminde tanımlananın dışında perkütan transvenöz mitral komissürotominin (PTMK) başarılı sonucunun prediktörlerini bilmek.
 
Yöntemler: Pakistan’da üçüncü basamak kalp merkezindeki bu gözlemsel çalışmaya Wilkin skoru ?8 olan ardışık 258 hasta dahil edildi. Hafiften daha fazla mitral regurjitasyonu (MR) olan veya sol atriumda pıhtısı olan hastalar çalışma dışı bırakıldı. Bonhoeffer multi-track sistemi ilk seçenek teknik olarak kullanıldı. Hafiften daha fazla MR olmaksızın ?1,5 cm2’lik mitral valv alanına (MVA) ulaşmak başarılı PTMK olarak tanımlandı.
 
Bulgular: 258 PTMK prosedürünün 197’si başarılı oldu. Bonhoeffer multi-track sistemi ~%94 olguda kullanıldı. Başarısız prosedürler arasında, 41 hasta gerekli kapak alanına ulaşamadı, 21 hastada hafiften daha fazla MR gelişti, bunlardan 8’inde istenilen kapak alanına ulaşılamadı ve hafiften daha fazla MR mevcuttu. Daha büyük ortalama anulus boyutu (32,8±2,1 mm’ye karşılık 33,5±2,6 mm, p=0,02) ve prosedür öncesi MVA (0,87±0,1 cm2’ye karşılık 0,93±0,1 cm2, p=0,002) başarılı PTMK üzerinde önemli etkiye sahipti. EKO’da (75,3±18 mm Hg’ya karşılık 65,4±19,4 mm Hg, p=0,000) ve yakalamada (81,5±24,6 mm Hg’ya karşılık 74±21,5 mm Hg, p=0,002) prosedür öncesi daha düşük ortalama sistolik sağ ventrikül basıncı, EKO’da daha düşük grade sol ventrikül disfonksiyonu (p=0,04) ve triküspit regürjitasyonu (p=0,003) sonuçlar üzerinde pozitif etkiye sahipti.

 
 
Sonuç: Hastanın daha büyük yapısı ve boyu, prosedür öncesi daha büyük mitral kapak anulus boyutu ve mitral kapak alanı ve daha iyi sağ ve sol ventrikül hemodinamikleri başarılı PTMK ile ilişkilidir.

Anahtar Kelimeler: perkütan transvenöz mitral komissürotomi, Bonhoeffer multi-track sistemi, prediktörler.

Muhammad Tariq Farman, Naveedullah Khan, Jawaid Akbar Sial, Tahir Saghir, Tariq Ashraf, Syed Ishtiaq Rasool, Khan Shah Zaman. Predictors of successful percutaneous transvenous mitral commissurotomy using the Bonhoeffer Multi-Track system in patients with moderate to severe mitral stenosis: Can we see beyond the Wilkins score?. Anatol J Cardiol. 2015; 15(5): 373-379
Manuscript Language: English


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