Competing Risk Analysis Of Mitral Valve Reintervention After Repeat Percutaneous Balloon Mitral Valvuloplasty

BackgroundAlthough percutaneous balloon mitral valvuloplasty(PBMV)brings good long-term prognosis to most patients with rheumatic mitral stenosis,there are still some patients who develop mitral restenosis with severe symptoms and therefore have to undergo mitral intervention again.The aim of this study was to focus on the mortality-adjusted mitral valve reintervention rate(through competing risk analysis)and its determinants through medium-and long-term follow-up of 123 patients receiving repeat PBMV treatment to screen candidates who are more suitable for repeat PBMV.MethodsIn this prospective cohort study,123 patients with mitral restenosis who received a second PBMV treatment at Jiangxi Provincial People’s Hospital from December2011 to April 2019 were recruited.To assess the long-term benefit of repeated PBMV,we recorded adverse events such as mitral valve re-intervention and death during follow-up,and treated cardiovascular death as a competitive risk factor for mitral valve re-intervention,using a competitive risk model to assess the average risk of repeated PBMV re-intervention.ResultsThe average age of the cohort was 54.18 ± 10.61 years at baseline.After repeat PBMV procedures,91 patients(74%)achieved good immediate results,and no adverse events occurred during hospitalization.In the presence of competing risk,the cumulative incidence of mitral valve reintervention 1,2,4,and 8 years after repeat PBMV was 6.72%,11.04%,17.42% and 28.4%,respectively.Multivariate competing risk analysis suggested that the Wilkins score(s HR: 1.55,95%CI:1.06-2.25,P=0.02)was independent predictors of mitral valve reintervention after repeat PBMV.Subgroup analysis showed that age 67 years old,Wilkins score 9,max mitral gradient 25 mm Hg,pulmonary artery peak systolic pressure 47 mm Hg,left atrial diameter 57 mm were considered to be the potential highest threshold for candidates receiving repeated PBMV therapy.ConclusionsRepeat PBMV is still a safe and effective treatment strategy for mitral restenosis after the first successful PBMV procedure,while patients<67 years old,patients with moderate valvular condition,patients with left atrial diameter less than 57 mm,max mitral valve gradient less than 25 mm Hg and pulmonary artery peak systolic pressure less than 47 mm Hg may be more suitable for repeat PBMV treatment.