The Experts below are selected from a list of 249 Experts worldwide ranked by ideXlab platform
Bertrand Cormier - One of the best experts on this subject based on the ideXlab platform.
-
Percutaneous mitral Commissurotomy: technique, results, and selection of patients.
Przegla̧d lekarski, 2020Co-Authors: Alec Vahanian, Bertrand Cormier, P. Luxereau, Eric Brochet, Bernard IungAbstract:Fifteen years of experience with percutaneous valve dilatation for mitral stenosis have shown the following: it is an effective treatment in a wide range of patients; its risk is low when it is performed by experienced teams, and more than 10 years follow-up demonstrates excellent durability of the procedure; the prediction of the immediate and long-term results is multifactorial and based on clinical and anatomic variables which should be taken into account when selecting the candidates for the procedure. Today balloon Commissurotomy is a substitute for surgical Commissurotomy and a complement to valve replacement.
-
long term efficacy of percutaneous mitral Commissurotomy for restenosis after previous mitral Commissurotomy
Heart, 2013Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, Alec VahanianAbstract:Objective We analysed long-term results of percutaneous mitral Commissurotomy (PMC) performed because of mitral restenosis after previous Commissurotomy. Design Follow-up of a prospective cohort. Setting Tertiary university hospital. Patients We studied 163 consecutive patients who underwent PMC because of restenosis occurring 16±8 years after previous Commissurotomy (closed-heart in 121, open-heart in 30 and PMC in 12). Mean age was 48±14 years; 62 patients (38%) had valve calcification. Restenosis was due to bicommissural fusion in all cases. Intervention PMC using a single or double balloon in 80 patients and the Inoue balloon in 83. Results Good immediate results (IR) (valve area ≥1.5 cm2 with MR≤2/4) were obtained in 135 pts (83%). 20-year rates were 27.9±4.7% for cardiovascular survival without mitral surgery and 14.8±3.9% for good functional results (cardiovascular survival without reintervention on the mitral valve and in New York Heart Association (NYHA) class I or II). After good IR, 20-year rates were 33.2±5.5% for cardiovascular survival without surgery and 17.9±4.7% for good functional results. After good IR, multivariate predictive factors of poor late functional results were higher NYHA class (p=0.01), atrial fibrillation (p=0.0002) and higher mean mitral gradient after PMC (p=0.004). Conclusions In patients with restenosis after mitral Commissurotomy, PMC provides good IR in most cases. After good IR, one patient out of three remains free from surgery and one out of five has good functional results at 20 years. These findings support the use of PMC after previous Commissurotomy, particularly in selected patients with few symptoms and in sinus rhythm.
-
late results of percutaneous mitral Commissurotomy up to 20 yearsclinical perspective development and validation of a risk score predicting late functional results from a series of 912 patients
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background— Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm 2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P P P P Conclusions— Twenty years after percutaneous mitral Commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.
-
late results of percutaneous mitral Commissurotomy up to 20 years
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background—Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results—Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (P<0.0001), interaction between age and final mitral valve area (P<0.0001) showing that the impact of valve area decreases wi...
-
late results of percutaneous mitral Commissurotomy up to 20 yearsclinical perspective
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background— Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P <0.0001), interaction between age and final mitral valve area ( P <0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification ( P <0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation ( P <0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. Conclusions— Twenty years after percutaneous mitral Commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome. # Clinical Perspective {#article-title-40}
Bernard Iung - One of the best experts on this subject based on the ideXlab platform.
-
Percutaneous mitral Commissurotomy: technique, results, and selection of patients.
Przegla̧d lekarski, 2020Co-Authors: Alec Vahanian, Bertrand Cormier, P. Luxereau, Eric Brochet, Bernard IungAbstract:Fifteen years of experience with percutaneous valve dilatation for mitral stenosis have shown the following: it is an effective treatment in a wide range of patients; its risk is low when it is performed by experienced teams, and more than 10 years follow-up demonstrates excellent durability of the procedure; the prediction of the immediate and long-term results is multifactorial and based on clinical and anatomic variables which should be taken into account when selecting the candidates for the procedure. Today balloon Commissurotomy is a substitute for surgical Commissurotomy and a complement to valve replacement.
-
long term efficacy of percutaneous mitral Commissurotomy for restenosis after previous mitral Commissurotomy
Heart, 2013Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, Alec VahanianAbstract:Objective We analysed long-term results of percutaneous mitral Commissurotomy (PMC) performed because of mitral restenosis after previous Commissurotomy. Design Follow-up of a prospective cohort. Setting Tertiary university hospital. Patients We studied 163 consecutive patients who underwent PMC because of restenosis occurring 16±8 years after previous Commissurotomy (closed-heart in 121, open-heart in 30 and PMC in 12). Mean age was 48±14 years; 62 patients (38%) had valve calcification. Restenosis was due to bicommissural fusion in all cases. Intervention PMC using a single or double balloon in 80 patients and the Inoue balloon in 83. Results Good immediate results (IR) (valve area ≥1.5 cm2 with MR≤2/4) were obtained in 135 pts (83%). 20-year rates were 27.9±4.7% for cardiovascular survival without mitral surgery and 14.8±3.9% for good functional results (cardiovascular survival without reintervention on the mitral valve and in New York Heart Association (NYHA) class I or II). After good IR, 20-year rates were 33.2±5.5% for cardiovascular survival without surgery and 17.9±4.7% for good functional results. After good IR, multivariate predictive factors of poor late functional results were higher NYHA class (p=0.01), atrial fibrillation (p=0.0002) and higher mean mitral gradient after PMC (p=0.004). Conclusions In patients with restenosis after mitral Commissurotomy, PMC provides good IR in most cases. After good IR, one patient out of three remains free from surgery and one out of five has good functional results at 20 years. These findings support the use of PMC after previous Commissurotomy, particularly in selected patients with few symptoms and in sinus rhythm.
-
late results of percutaneous mitral Commissurotomy up to 20 yearsclinical perspective development and validation of a risk score predicting late functional results from a series of 912 patients
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background— Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm 2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P P P P Conclusions— Twenty years after percutaneous mitral Commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.
-
late results of percutaneous mitral Commissurotomy up to 20 years
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background—Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results—Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (P<0.0001), interaction between age and final mitral valve area (P<0.0001) showing that the impact of valve area decreases wi...
-
late results of percutaneous mitral Commissurotomy up to 20 yearsclinical perspective
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background— Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P <0.0001), interaction between age and final mitral valve area ( P <0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification ( P <0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation ( P <0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. Conclusions— Twenty years after percutaneous mitral Commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome. # Clinical Perspective {#article-title-40}
Igor F Palacios - One of the best experts on this subject based on the ideXlab platform.
-
Farewell to Surgical Mitral Commissurotomy for Many Patients
Circulation, 1998Co-Authors: Igor F PalaciosAbstract:Percutaneous mitral balloon valvotomy (PMV) has been accepted as an alternative to surgical mitral Commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Previous studies have demonstrated that PMV produces good immediate and long-term follow-up results in a selected group of patients with mitral stenosis.1 2 3 4 Hemodynamic and clinical improvement is achieved in the majority of patients with rheumatic mitral stenosis. PMV resulted in a significant decrease in mitral gradient and an increase in mitral valve area with minimal morbidity and mortality. The majority of patients have a marked clinical improvement, and the hemodynamic and clinical improvement produced by PMV persist at long-term follow-up.2 3 4 On the other hand, surgical mitral Commissurotomy has been used successfully for many years to treat patients with mitral stenosis. The results of closed or open surgical mitral Commissurotomy have demonstrated favorable immediate and long-term hemodynamic and symptomatic improvement in selected patients with rheumatic mitral stenosis. Interpretation of long-term clinical follow-up of patients undergoing percutaneous mitral balloon valvuloplasty as well as their comparison with surgical Commissurotomy series are confounded by heterogeneity in the patient population. Only few randomized studies have compared the results of PMV with those of surgical Commissurotomy. In this issue of the journal, Farhat et al5 reported the results of a randomized trial designed to compare the immediate and long-term results of double-balloon PMV versus those of open and closed surgical mitral Commissurotomy in a cohort of patients with severe rheumatic mitral stenosis. These patients were, from the clinical and morphological point of view, optimal candidates for both PMV and surgical Commissurotomy (closed or open) procedures as demonstrated by a mean age of
-
farewell to surgical mitral Commissurotomy for many patients
Circulation, 1998Co-Authors: Igor F PalaciosAbstract:Percutaneous mitral balloon valvotomy (PMV) has been accepted as an alternative to surgical mitral Commissurotomy in the treatment of patients with symptomatic rheumatic mitral stenosis. Previous studies have demonstrated that PMV produces good immediate and long-term follow-up results in a selected group of patients with mitral stenosis.1 2 3 4 Hemodynamic and clinical improvement is achieved in the majority of patients with rheumatic mitral stenosis. PMV resulted in a significant decrease in mitral gradient and an increase in mitral valve area with minimal morbidity and mortality. The majority of patients have a marked clinical improvement, and the hemodynamic and clinical improvement produced by PMV persist at long-term follow-up.2 3 4 On the other hand, surgical mitral Commissurotomy has been used successfully for many years to treat patients with mitral stenosis. The results of closed or open surgical mitral Commissurotomy have demonstrated favorable immediate and long-term hemodynamic and symptomatic improvement in selected patients with rheumatic mitral stenosis. Interpretation of long-term clinical follow-up of patients undergoing percutaneous mitral balloon valvuloplasty as well as their comparison with surgical Commissurotomy series are confounded by heterogeneity in the patient population. Only few randomized studies have compared the results of PMV with those of surgical Commissurotomy. In this issue of the journal, Farhat et al5 reported the results of a randomized trial designed to compare the immediate and long-term results of double-balloon PMV versus those of open and closed surgical mitral Commissurotomy in a cohort of patients with severe rheumatic mitral stenosis. These patients were, from the clinical and morphological point of view, optimal candidates for both PMV and surgical Commissurotomy (closed or open) procedures as demonstrated by a mean age of <30 years, absence of mitral valve calcification on fluoroscopy and two-dimensional echocardiography, and an echocardiographic score ≤8 in all patients. Their …
-
four year follow up of patients undergoing percutaneous balloon mitral Commissurotomy a report from then national heart lung and blood institute balloon valvuloplasty registry
Journal of the American College of Cardiology, 1996Co-Authors: Larry S Dean, Igor F Palacios, Mary Mickel, Kathryn B. Davis, Raoul Bonan, David R Holmes, William W Oneill, Shahbudin H Rahimtoola, James Slater, Ward J KennedyAbstract:Objectives. This study reports the long-term outcome of patients undergoing percutaneous balloon mitral Commissurotomy who were enrolled in the National Heart, Lung, and Blood Institute (NHLBI) Balloon Valvuloplasty Registry. Background. The NHLBI established the multicenter Balloon Valvuloplasty Registry in November 1987 to assess both short-and long-term safety and efficiency of percutaneous balloon mitral Commissurotomy. Methods. Between November 1987 and October 1989, 736 patients ≥18 years old underwent percutaneous balloon mitral Commissurotomy at 23 registry sites in North America. The maximal follow-up period was 52 years. Results. The actuarial survival rate was 93 ± 1% (mean ± SD), 90 ± 1.2%, 87 ± 1.4% and 84 ± 1.6% at 1, 2, 3 and 4 years, respectively. Eighty percent of the patients were alive and free of mitral surgery or repeat balloon mitral Commissurotomy at 1 year. The event-free survival rate was 80 ± 1.5% at 1 year, 71 ± 1.7% at 2 years, 66 ± 1.8% at 3 years and 60 ± 2.0% at 4 years. Important univariable predictors of actuarial mortality at 4 years included age >70 years (51% survival), New York Heart Association functional class IV (41% survival) and baseline echocardiographic score >12 (24% survival). Multivariable predictors of mortality included functional class IV, higher echocardiographic score and higher postprocedural pulmonary artery systolic and left ventricular end-diastolic pressures (p < 0.01). Conclusions. Percutaneous balloon mitral Commissurotomy has a favorable effect on the hemodynamic variables of mitral stenosis, and long-term follow-up data suggest that it is a viable alternative with respect to surgical Commissurotomy in selected patients.
-
percutaneous mitral balloon valvotomy for recurrent mitral stenosis after surgical Commissurotomy
American Journal of Cardiology, 1995Co-Authors: Ikkyung Jang, Peter C Block, John B Newell, Murat E Tuzcu, Igor F PalaciosAbstract:Abstract Immediate outcome and 4-year follow-up results of percutaneous mitral balloon valvotomy (PMV) in patients with previous surgical mitral Commissurotomy are studied. Repeat surgical mitral Commissurotomy in patients with previous surgical Commissurotomy is associated with higher mortality and morbidity. PMV has been proven to be safe and could be an ideal alternative in this patient group. The results of 68 patients with previous surgical Commissurotomy were compared with those of 261 patients without prior surgical intervention. A good outcome, defined as the final mitral valve area >1.5 cm 2 , was obtained in 51% of the patients with prior surgical Commissurotomy compared with 71% in the control group (p = 0.002). During the 4-year follow-up period, there were more patients who required mitral valve replacement (19% vs 7%; p = 0.004) and who were in New York Heart Association functional class III and IV (85% vs 71%; p = 0.02) among those with prior surgical Commissurotomy. However, when these patients were divided according to echocardiographic score, those with a score ≤8 had immediate outcome and long-term results similar to those without prior Commissurotomy. PMV can be performed safely in patients with prior surgical Commissurotomy. Although results of long-term follow-up in these patients is not as good as those in patients without prior surgical Commissurotomy, those with a low echocardiographic score had similar excellent long-term results.
Alec Vahanian - One of the best experts on this subject based on the ideXlab platform.
-
Percutaneous mitral Commissurotomy: technique, results, and selection of patients.
Przegla̧d lekarski, 2020Co-Authors: Alec Vahanian, Bertrand Cormier, P. Luxereau, Eric Brochet, Bernard IungAbstract:Fifteen years of experience with percutaneous valve dilatation for mitral stenosis have shown the following: it is an effective treatment in a wide range of patients; its risk is low when it is performed by experienced teams, and more than 10 years follow-up demonstrates excellent durability of the procedure; the prediction of the immediate and long-term results is multifactorial and based on clinical and anatomic variables which should be taken into account when selecting the candidates for the procedure. Today balloon Commissurotomy is a substitute for surgical Commissurotomy and a complement to valve replacement.
-
long term efficacy of percutaneous mitral Commissurotomy for restenosis after previous mitral Commissurotomy
Heart, 2013Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, Alec VahanianAbstract:Objective We analysed long-term results of percutaneous mitral Commissurotomy (PMC) performed because of mitral restenosis after previous Commissurotomy. Design Follow-up of a prospective cohort. Setting Tertiary university hospital. Patients We studied 163 consecutive patients who underwent PMC because of restenosis occurring 16±8 years after previous Commissurotomy (closed-heart in 121, open-heart in 30 and PMC in 12). Mean age was 48±14 years; 62 patients (38%) had valve calcification. Restenosis was due to bicommissural fusion in all cases. Intervention PMC using a single or double balloon in 80 patients and the Inoue balloon in 83. Results Good immediate results (IR) (valve area ≥1.5 cm2 with MR≤2/4) were obtained in 135 pts (83%). 20-year rates were 27.9±4.7% for cardiovascular survival without mitral surgery and 14.8±3.9% for good functional results (cardiovascular survival without reintervention on the mitral valve and in New York Heart Association (NYHA) class I or II). After good IR, 20-year rates were 33.2±5.5% for cardiovascular survival without surgery and 17.9±4.7% for good functional results. After good IR, multivariate predictive factors of poor late functional results were higher NYHA class (p=0.01), atrial fibrillation (p=0.0002) and higher mean mitral gradient after PMC (p=0.004). Conclusions In patients with restenosis after mitral Commissurotomy, PMC provides good IR in most cases. After good IR, one patient out of three remains free from surgery and one out of five has good functional results at 20 years. These findings support the use of PMC after previous Commissurotomy, particularly in selected patients with few symptoms and in sinus rhythm.
-
Long‐Term Results After Percutaneous Balloon Mitral Commissurotomy
Journal of Interventional Cardiology, 2000Co-Authors: Alec Vahanian, Bernard Iung, Yasuhiro Makita, Bertrand Cormier, P. LuxereauAbstract:We are now able to analyze follow-up data up to 10 years after percutaneous mitral Commissurotomy (PMC). In clinical terms, several large single-center series confirm the late efficacy of the procedure in a large population, comprising a variety of patient subsets. When the immediate results are unsatisfactory, prognosis is poor and surgery should be carried out when the clinical conditions allow it. Conversely, if PMC is initially successful, the clinical results are excellent and late deterioration is mainly related to restenosis. Preliminary series have shown that repeat balloon Commissurotomy may be performed successfully in such patients. The prediction of late results after balloon Commissurotomy is multifactorial and based on clinical parameters, valve anatomy, and the immediate results of the procedure. Randomized studies have shown that the long-term results of balloon Commissurotomy are as good as those of surgery in patients with favorable characteristics. In the others, there has been no comparative study and patient selection should take into account the multifactorial nature of the prediction of late results. Overall, these good long-term results have led to an increased use of balloon Commissurotomy in the treatment of patients with mitral stenosis.
-
functional results 5 years after successful percutaneous mitral Commissurotomy in a series of 528 patients and analysis of predictive factors
Journal of the American College of Cardiology, 1996Co-Authors: Bernard Iung, Bertrand Cormier, Jean Marc Porte, O Nallet, P L Michel, J Acar, Pierre Ducimetiere, Alec VahanianAbstract:OBJECTIVES: This study sought to assess late functional results after successful percutaneous mitral Commissurotomy and to determine their predictors. BACKGROUND: Few studies have reported late results of percutaneous mitral Commissurotomy or have analyzed their late results regardless of immediate results, despite the fact that late deterioration may well be related either to a decrease in valve area or to poor initial results. METHODS: Between 1986 and 1992, 528 patients underwent successful percutaneous mitral Commissurotomy (mean [+/- SD] age 46 +/- 18 years; mean follow-up 32 +/- 18 months). A successful procedure was defined by a mitral valve area > or = 1.5 cm2 and no regurgitation > 2/4. Dilation was performed using a single balloon in 13 patients, a double balloon in 349 and the Inoue balloon in 166. Multivariate analysis was performed with a Cox model. RESULTS: The survival rate for patients in New York Heart Association functional class I or II, with no cardiac-related deaths or need for mitral surgery or repeat dilation, was 76 +/- 6% at 5 years. By multivariate analysis, the independent predictors of good functional results were echocardiographic group (p = 0.01), functional class (p = 0.02) and cardiothoracic index (p = 0.005) before the procedure and valve area after the procedure (p = 0.007). The predictive model derived allowed estimation of the probability of good functional results according to the value of these four predictors for any given patient. CONCLUSIONS: Good functional results were observed 5 years after successful percutaneous mitral Commissurotomy in a large series of varied patients. The analysis of predictive factors may provide useful indications for follow-up results in patients undergoing this technique.
-
early assessment by transesophageal echocardiography of left atrial appendage function after percutaneous mitral Commissurotomy
American Journal of Cardiology, 1996Co-Authors: Jean Marc Porte, Bernard Iung, P L Michel, Bertrand Cormier, E Dadez, C Starkman, O Nallet, J Acar, Alec VahanianAbstract:Abstract Thirty-seven consecutively admitted patients with severe mitral stenosis underwent percutaneous mitral Commissurotomy with a transthoracic and biplane or multiplane transesophageal echocardiographic examination before and between 24 and 48 hours after percutaneous mitral Commissurotomy. Thirty patients (81%) were in sinus rhythm and 7 were in atrial fibrillation. Left atrial appendage (LAA) function was evaluated in both the transverse and the longitudinal planes by planimetry and pulsed Doppler echocardiographic interrogation at the LAA outlet. Percutaneous mitral Commissurotomy resulted in a twofold increase in mitral valve area, and no severe mitral regurgitation occurred. With use of the planimetry method, there was no significant improvement in LAA ejection fraction, except in the transverse plane for patients in sinus rhythm (p = 0.03). With use of Doppler method, 3 distinct flow patterns were observed before the procedure: a “sinus pattern” in patients in sinus rhythm, and a “fibrillatory pattern” (n = 3) or a “no-flow pattern” (n = 4) in patients in atrial fibrillation. After Commissurotomy, mere was a marked increase in LAA peak Doppler velocity (+62%) and in LAA velocity time integral (+31%). Of the 4 patients in atrial fibrillation with a no-flow pattern, 2 had recovery of a typical effective fibrillatory flow pattern after the procedure. The increase in peak Doppler velocity after Commissurotomy was related to the decrease or regression in left atrial spontaneous echo contrast, and correlated with the increase in mitral valve area, the decrease in transmitral pressure gradient, and the increase in cardiac index; improvement in valve function after successful percutaneous mitral Commissurotomy is associated with early improvement in LAA function.
P L Michel - One of the best experts on this subject based on the ideXlab platform.
-
late results of percutaneous mitral Commissurotomy up to 20 yearsclinical perspective development and validation of a risk score predicting late functional results from a series of 912 patients
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background— Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm 2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P P P P Conclusions— Twenty years after percutaneous mitral Commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome.
-
late results of percutaneous mitral Commissurotomy up to 20 years
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background—Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results—Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient (P<0.0001), interaction between age and final mitral valve area (P<0.0001) showing that the impact of valve area decreases wi...
-
late results of percutaneous mitral Commissurotomy up to 20 yearsclinical perspective
Circulation, 2012Co-Authors: Claire Bouleti, Bernard Iung, Eric Garbarz, Bertrand Cormier, Cedric Laouenan, Dominique Himbert, Eric Brochet, David Messikazeitoun, Delphine Detaint, P L MichelAbstract:Background— Long-term follow-up after percutaneous mitral Commissurotomy enables predictive factors of late results to be identified. Methods and Results— Late results of percutaneous mitral Commissurotomy were assessed in 1024 consecutive patients. Good immediate results, defined as valve area ≥1.5 cm2 without mitral regurgitation >2/4, were obtained in 912 patients (89%). These 912 patients were randomly split into 2 cohorts comprising 609 and 303 patients that were used to develop and validate, respectively, a scoring system predicting late functional results. The 20-year rate of good functional results (survival without cardiovascular death, mitral surgery, or repeat percutaneous mitral Commissurotomy and in New York Heart Association class I or II) was 30.2±2.0%. A multivariable Cox model identified 7 predictive factors of poor late functional results: higher final mean gradient ( P <0.0001), interaction between age and final mitral valve area ( P <0.0001) showing that the impact of valve area decreases with age, interaction between sex and valve calcification ( P <0.0001) showing that the impact of valve anatomy is stronger in men, and interaction between rhythm and New York Heart Association class showing an impact of New York Heart Association class only in patients in atrial fibrillation ( P <0.0001). A 13-point score enabled 3 risk groups to be defined, corresponding to predicted good functional results of 55.1%, 29.1%, and 10.5% at 20 years in the validation cohort. Conclusions— Twenty years after percutaneous mitral Commissurotomy in a population of patients with varied characteristics, 30% still had good functional results. Prediction of late functional results is multifactorial and strongly determined by age and the quality of immediate results. A simple validated scoring system is useful for estimating individual patient outcome. # Clinical Perspective {#article-title-40}
-
immediate and mid term results of repeat percutaneous mitral Commissurotomy for restenosis following earlier percutaneous mitral Commissurotomy
European Heart Journal, 2000Co-Authors: Bernard Iung, Eric Garbarz, Pierre Michaud, Steeven Helou, Patricia Berdah, P L Michel, Olivier Fondard, J Kamblock, P Lionet, Bertrand CormierAbstract:Aims This study assessed the results of repeat percutaneous mitral Commissurotomy for mitral restenosis following a first procedure. Methods and Results Repeat balloon Commissurotomy was performed in 53 patients who had symptomatic restenosis a mean of 6±2 years (2–11) after a successful first procedure; seven patients had mildly calcified valves. All patients had restenosis with a fusion of both commissures as assessed by echocardiography. A double-balloon was used in one case and the Inoue technique in 52. Complications were stroke in one patient and severe mitral regurgitation (Sellers grade 3) in two. Valve area increased from 1·03±0·22 to 1·82±0·21cm2( P 2/4, were obtained in 48 patients (91%). The 5-year survival rate without operation and in NYHA class I or II was 69±11% in the whole population, and 76±11% in the 48 patients who had had good immediate results. Conclusion This study suggests that repeat balloon Commissurotomy is a valid treatment for symptomatic restenosis after a first successful procedure. It gives good results in patients selected on the basis of favourable characteristics and the echocardiographic analysis of the mechanism of restenosis.
-
functional results 5 years after successful percutaneous mitral Commissurotomy in a series of 528 patients and analysis of predictive factors
Journal of the American College of Cardiology, 1996Co-Authors: Bernard Iung, Bertrand Cormier, Jean Marc Porte, O Nallet, P L Michel, J Acar, Pierre Ducimetiere, Alec VahanianAbstract:OBJECTIVES: This study sought to assess late functional results after successful percutaneous mitral Commissurotomy and to determine their predictors. BACKGROUND: Few studies have reported late results of percutaneous mitral Commissurotomy or have analyzed their late results regardless of immediate results, despite the fact that late deterioration may well be related either to a decrease in valve area or to poor initial results. METHODS: Between 1986 and 1992, 528 patients underwent successful percutaneous mitral Commissurotomy (mean [+/- SD] age 46 +/- 18 years; mean follow-up 32 +/- 18 months). A successful procedure was defined by a mitral valve area > or = 1.5 cm2 and no regurgitation > 2/4. Dilation was performed using a single balloon in 13 patients, a double balloon in 349 and the Inoue balloon in 166. Multivariate analysis was performed with a Cox model. RESULTS: The survival rate for patients in New York Heart Association functional class I or II, with no cardiac-related deaths or need for mitral surgery or repeat dilation, was 76 +/- 6% at 5 years. By multivariate analysis, the independent predictors of good functional results were echocardiographic group (p = 0.01), functional class (p = 0.02) and cardiothoracic index (p = 0.005) before the procedure and valve area after the procedure (p = 0.007). The predictive model derived allowed estimation of the probability of good functional results according to the value of these four predictors for any given patient. CONCLUSIONS: Good functional results were observed 5 years after successful percutaneous mitral Commissurotomy in a large series of varied patients. The analysis of predictive factors may provide useful indications for follow-up results in patients undergoing this technique.