Outcome of percutaneous mitral balloon valvuloplasty: Comparison of the Inoue and retrograde non-transseptal techniques. A single-center experience

Introduction. The transseptal Inoue (IN) and to a lesser extent retrograde non-transseptal (RNT) techniques are established procedures for percutaneous mitral balloon valvuloplasty (PBMV) in patients with mitral stenosis. However, a head to head comparison of these two techniques, especially from a single center, has not yet been reported. Methods. Seventy-two consecutive patients (n = 35 IN and n = 37 RNT) underwent PMBV in our clinic from October 1993 to December 1999. All baseline and procedural characteristics were compared, as well as immediate and long-term outcomes (mean follow-up, 42 ± 12 months) of the patients. Results. Baseline characteristics were similar in the two groups. A successful immediate result was achieved in 91% of IN patients and 89% of RNT patients. After the PMBV, mitral valve area (MVA) increased from 1.04 ± 0.16 cm² to 1.6 ± 0.3 cm² and from 1.06 ± 0.23 cm² to 1.55 ± 0.3 cm² in the IN group and RNT group, respectively (p = NS). There was a higher percentage of mild mitral regurgitation (MR) after the RNT technique (p = 0.03). Mean fluoroscopy time was 31 ± 16 minutes in the IN group and 39 ± 11 minutes in the RNT group (p = 0.02). After discharge, major adverse cardiac events (MACE: mitral valve replacement, repeat PMBV) occurred in 3 patients (8%) patients in the IN group and 5 patients (13.5%) in the RNT group (p = NS). Follow-up echocardiographic evaluation revealed no significant changes regarding MVA in either group. Conclusions. The IN and RNT techniques are comparable regarding the achieved MVA, with slightly more frequent MR post-RNT PBMV. IN requires significantly less fluoroscopy time. MACE and event-free survival rates at follow-up were similar in the two groups.