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Page 16 of 24 Palacios Mini-invasive Surg 2020;4:73 I http://dx.doi.org/10.20517/2574-1225.2020.72

Figure 14. Kaplan-Meier event-free survival estimates (alive and free of MVR or redo PMV) for patients with Echo-Sc ≤ 8, Echo-Sc 9 to
11, and Echo-Sc ≥ 12. Modified from Palacios IF, Sanchez PL, Harrell LC, Weyman AE, Block PC. Which patients benefit from percutaneous
mitral balloon valvuloplasty? Pre and post-valvuloplasty variables that predict 15-year outcome [13] . PMV: percutaneous mitral balloon
valvuloplasty; MVR: mitral valve replacement

Conversely, patients with Echo-Sc ≥ 12 should be referred for MVR, because only 36% had successful PMV
and only 10% were free of events at 4 years post-PMV [Figure 14]. Nevertheless, PMV could be considered
as a palliative procedure if the patients are non or very high surgical candidates.

PMV IN PATIENTS WITH PREVIOUS SURGICAL COMMISSUROTOMY
Although the increase in MVA with PMV is inversely related to the presence of previous surgical mitral
commissurotomy, PMV can produce a good outcome in this group of patients. The post-PMV mean
2
MVA in 154 patients with previous surgical commissurotomy was 1.8 ± 0.7 cm compared with an MVA
2
of 1.9 ± 0.6 cm in patients without previous surgical commissurotomy P < 0.05). In this group of patients,
an echocardiographic score ≤ 8 was an important predictor of a successful hemodynamic immediate
[48]
outcome . This application for PMV assumes that the mechanism of restenosis after surgical mitral
commissurotomy is due to commissural fusion as determined by echocardiography.

REDO PMV IN PATIENTS WITH POST-PMV MITRAL RESTENOSIS
PMV for mitral restenosis is feasible, safe, and achieves immediate and long-term outcome comparable to
[49]
initial PMV . We reported the immediate outcome and long-term clinical follow-up results of 36 patients
(mean age 58 ± 13 years, 75% women) with symptomatic mitral restenosis after prior PMV, who were
[49]
treated with a repeat PMV at 34.6 ± 28 months after the initial PMV . The mean follow-up period was 30
± 33 months with a maximal follow-up of 10 years. An immediate procedural success was obtained in 75%
patients. The overall survival rate was 74%, 72%, and 71% at one, two, and three years, respectively. The
event-free survival rate was 61%, 54% and 47% at one, two, and three years, respectively. In the presence