A Comparison of Immediate Outcomes of Redo Percutaneous Transvenous Mitral Commissurotomy with the First Percutaneous Transvenous Mitral Commissurotomy - A Retrospective Analysis

Aims and objectives: To compare immediate and in hospital outcomes of patients undergoing Redo Percutaneous Transvenous Mitral Commissurotomy(PTMC) with outcomes in patients undergoing PTMC for the first time. To compare the grading of Mitral Regurgitation(MR) and Mean Mitral Valve Area(MVA) in patients undergoing Redo PTMC and PTMC first time at the end of one year of follow-up.

Materials and methods: It is a retrospective study conducted at Southern Railway Headquarters Hospital- a tertiary hospital in Chennai on a total of 148 patients who underwent First and Redo Percutaneous Transvenous Mitral Commissurotomy (PTMC) as part of the treatment for the same during the period from 1st January 2010 to 31st December 2018, and having minimum follow up of atleast 1 year, were taken into study based on inclusion and exclusion criteria.

Results: A total of 148 patients were included in the study, of which seventy four patients were in the First Percutaneous Transvenous Mitral Commissurotomy (PTMC) group and other seventy four patients were in the Redo PTMC group. After PTMC procedure, mean Mitral valve area increased to 1.95 ± 0.14 cm2 in the First PTMC group and 1.82 ± 0.09 cm2 in the Redo PTMC group(p=0.001). Immediately after PTMC procedure, 73 patients (98.7%) had grade I and grade II Mitral regurgitation and 1 patient (1.3%) had grade III Mitral regurgitation in the First PTMC group. Immediately after PTMC procedure, 70 patients (94.6%) had grade I and grade II Mitral regurgitation and 4 patients (5.4%) had grade III and grade IV Mitral regurgitation in the Redo PTMC group (p=0.02). Immediate procedural success was observed in 73 patients (98.6%) in the First PTMC group and 70 patients (94.5%) in the Redo PTMC group. At the end of 1 year after PTMC procedure, mean Mitral valve area in the First PTMC group was 1.90 ± 0.11 cm2 and in Redo PTMC group it was 1.77 ± 0.09 cm2(p=0.001). At the end of 1 year after PTMC procedure, 71 patients (95.9%) had grade I and grade II Mitral regurgitation and 3 patients (4.1%) had grade III Mitral regurgitation in the First PTMC group. 63 patients (86.4%) had grade I and grade II Mitral regurgitation and 10 patients (13.6%) had grade III and grade IV Mitral regurgitation at the end of 1 year after PTMC procedure in the Redo PTMC group (0.03).

Conclusion:-Redo Percutaneous Transvenous Mitral Commissurotomy(PTMC) for the patients who have mitral valve restenosis can be performed with a high success rate and low risk, although immediate and mid-term results are marginally inferior compared with patients who undergo PTMC as an initial procedure.