Cardiology Letters 2025, 34(1):11-17

Navigating risks and rewards in percutaneous transcatheter mitral commissurotomy: A multicenter hemodynamic analysis of safety and efficacy in symptomatic mitral stenosis

Soumik Ghosh¹, Tusharkanti Patra², Arjun Tandon¹, Vikas Agrawal¹

¹ Department of Cardiology, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India

² Department of Cardiology, Institute of Postgraduate Medical Education & Research, Kolkata, West Bengal, India

Aims: This study evaluates the safety and efficacy of Percutaneous Transcatheter Mitral Commissurotomy (PTMC) in treating symptomatic rheumatic mitral stenosis (MS), using invasive hemodynamic parameters. PTMC, a less invasive alternative to surgical mitral valvotomy, is widely used for severe MS but involves risks like mitral regurgitation (MR) and procedural complications. We aimed to assess PTMC's safety through changes in left ventricular end-diastolic pressure (LVEDP) and efficacy via reductions in left atrial pressure (LAP) in a multicenter cohort.

Methods: This prospective, two-year study included 328 patients undergoing PTMC at IPGIMERSSKM, Kolkata, and IMS-BHU, Varanasi, India. Patients were symptomatic, over 18 years old, and had severe MS (MVA ≤1.5 cm²) with favorable valve morphology. Exclusions included left atrial thrombus, significant MR, and additional valve disease. PTMC was performed with a 24-28 mm Accura balloon catheter. Outcomes were grouped by procedural safety (LVEDP increase <50%) and efficacy (LAP reduction ≥50%).

Results: The mean participant age was 37.92 years, with 72.2% female. Procedures were both safe and efficacious in 26.83% of cases, and safe but inefficacious in 32.32%. Older patients were more likely to have unfavorable outcomes (p=0.0012), with no significant gender-based differences.

Conclusion: PTMC effectively reduces LAP in severe MS but involves risks, particularly for older patients with complex valve morphology. PTMC is beneficial when performed in experienced centers, but careful patient selection and further long-term studies are essential to enhance procedural outcomes.

Keywords: Efficacy; Hemodynamics; Mitral Stenosis; PTMC; Safety

Published: January 1, 2025  Show citation