Predictors of One-Year Restenosis After Percutaneous Mitral Balloon Valvuloplasty in Rheumatic Mitral Stenosis: Real-World Data From 555 Patients and the Limited Impact of Periinterventional Transesophageal Echocardiography - Uncorrected Proof

Objective: Mitral balloon valvuloplasty remains an established first-line treatment for appropriately selected patients with rheumatic mitral stenosis. However, predictors of long-term restenosis and the additional value of periinterventional transesophageal echocardiography remain incompletely defined.

Method: This retrospective, single-center study included 555 patients who underwent percutaneous mitral balloon valvuloplasty for rheumatic mitral stenosis between January 2010 and January 2025 at Mehmet Akif Ersoy Heart Center, İstanbul, Türkiye. Patients were divided according to the presence or absence of restenosis at the 1-year follow-up. Restenosis was defined as a mitral valve area <1.5 cm². Procedural success was defined as less than moderate mitral regurgitation at the end of the procedure and the absence of transseptal puncture-related complications. Clinical, echocardiographic, procedural, and laboratory variables were analyzed to identify predictors of restenosis and procedural success.

Results: Restenosis occurred in 94 patients (17%). The mean age of the overall cohort was 47.81±12.29 years, and 467 patients (84.1%) were female. Patients with restenosis had higher preprocedural systolic pulmonary artery pressure, postprocedural transmitral gradient, postprocedural systolic pulmonary artery pressure, and preprocedural Wilkins score. In multivariable analysis, only the preprocedural Wilkins score remained an independent predictor of restenosis (OR: 1.907, 95% CI: 1.339–2.718, P < 0.001). Post-balloon transmitral gradient and postprocedural left atrial pressure ≥12 mmHg were associated with procedural success. Periinterventional transesophageal echocardiography was not associated with restenosis or procedural success.

Conclusion: In patients undergoing percutaneous mitral balloon valvuloplasty for rheumatic mitral stenosis, the preprocedural Wilkins score was the only independent predictor of 1-year restenosis. Routine periinterventional transesophageal echocardiography did not significantly influence procedural success or long-term restenosis rates. These findings suggest that, in appropriately selected patients, percutaneous mitral balloon valvuloplasty can be safely and effectively performed under transthoracic echocardiographic guidance without routine periinterventional transesophageal echocardiography.

Keywords: Echocardiography, mitral valve, restenosis.