(P095) SAFETY OF PERCUTANEOUS MITRAL BALLOON VALVULOPLASTY IN SEVERE RHEUMATIC MITRAL STENOSIS AND LEFT ATRIAL APPENDAGE THROMBUS

Saturday, October 26, 2024

1:30 PM – 2:00 PM PT

Location: BOARD 59

Presenting Author(s)

AA

Abdullah Alfaifi, MD

Internal Medicine Resident
Toronto, Ontario, Canada

First Author(s)

MM

Melissa Moey, MD MSc

Interventional Cardiology Fellow
Toronto, Ontario, Canada

Author(s)

AA

Abdullah Alfaifi, MD

Internal Medicine Resident
Toronto, Ontario, Canada
EE

Esam Elbarasi, MBChB FRCPC

Interventional Cardiology Fellow
Toronto, Ontario, Canada
SB

Shahrukh Bakar, MD

Interventional Cardiology Fellow
Toronto, Ontario, Canada
Geraldine Ong, n/a

Cardiologist-Echocardiographer
Unity Health Toronto – St. Michael’s Hospital
University of Toronto
Toronto, Ontario, Canada

Senior Author(s)

Neil P. Fam, MD

Associate Professor
University of Toronto
University of Toronto
Toronto, Ontario, Canada

Supervisor(s)

SA

Sami Alnasser, MD

Associate Professor
University of Toronto
Toronto, Ontario, Canada

Disclosure(s):

Abdullah Alfaifi, MD: No financial relationships to disclose

Background: Left atrial appendage (LAA) thrombus complicates rheumatic mitral valve stenosis (MS) and precludes percutaneous mitral balloon valvuloplasty (PMBV) as per contemporary guidelines, given the potential stroke risk. Surgical mitral valve replacement (MVR), commonly with mechanical valves, emerges as an alternative, albeit more invasive option associated with long-term complications and potentially reduced survival rates. As a result, it is unknown how the two approaches compare in the setting of LAA thrombus, including the risk of PMBV-related stroke.

METHODS AND RESULTS: We conducted a retrospective case series of patients with severe rheumatic MS and concomitant LAA thrombus who underwent PMBV between 2013 and 2023 at St. Michael’s Hospital in Toronto, Canada. We also reviewed the outcomes of patients with rheumatic MS who underwent MVR. The endpoint was a 30-day outcome including death, stroke, major bleeding, re-operation and hospital length of stay (LOS).

Between 2013 and 2023, 7 patients (63 ± 2.6 years old, 86% female) had severe rheumatic MS and LAA thrombus who underwent PMBV. The mitral mean gradient (MG) at baseline was 10 ± 5 mmHg, which reduced to 6 ± 1.8 mmHg following PMBV. There was a total of 19 patients (57 ± 13 years old, 79% female) who underwent MVR for severe rheumatic MS. The mitral MG at baseline was 11.2 ± 2.8 mmHg, reduced to 4.3 ± 1.2 mmHg following MVR. There were no deaths or strokes after PMBV or MVR within 30 days. There were no incidences of bleeding or rehospitalization following PMBV. In contrast, there were 4 (21%) patients following MVR who had major bleeding and 2 (11%) were re-hospitalized for cardiac tamponade and worsening pleural effusion requiring pericardiocentesis. Hospital LOS was significantly longer in patients with MVR than PMBV (8.9 ± 5.6 vs 1 day, respectively, p< 0.01).

Conclusion: In this small case series, 30-day stroke was not observed following PMBV among patients with severe rheumatic MS and LAA thrombus with favourable safety profiles and hospital length of stay. Larger studies are needed to determine the best approach to treating symptomatic rheumatic MS patients with LAA thrombus.