Pooled analysis of percutaneous mitral valvuloplasty in Egypt.

BACKGROUND: Till now, no pooled analysis summarizing the Egyptian experience in percutaneous mitral valvuloplasty (PMV) exists. OBJECTIVES AND METHODS: To pool the data of PMV procedures and perform a new analysis regarding the immediate outcome and follow-up results as well as to compare the results of different techniques. RESULTS: Patients (2,256) with mitral stenosis of rheumatic origin were included, 292 males and 1,964 females. Double balloon (DB) was used in 1,148 patients (51%), Inoue balloon (IB) in 914 patients (40.5%), metallic commissurotome (MC) in 142 patients (6%), Multi-Track in 33 patients (1.5%), and single balloon in 19 patients (1%). The mitral valve area (MVA) increased from 0.94 +/- 0.18 cm2 to 1.92 +/- 0.36 cm2; mean pressure gradient dropped from 15.94 +/- 5.46 mmHg to 5.85 +/- 2.6 mmHg. The most common complication was the occurrence of a new mitral regurgitation (MR) and/or increase in its grade (36%). Inadequate dilatation occurred in 192 patients (8.5%). Follow-up data (for 5.7 +/- 5.9 months) showed that the immediate results of PMV on MVA persisted through the follow-up period (1.78 +/- 0.35 cm2). Multi-Track system resulted in the largest increase in MVA and also resulted in the largest immediate increase in the grade of MR. CONCLUSIONS: This study confirms the success of PMV and its results during follow-up. The Multi-Track system, and the DB resulted in the largest MVA, the IB and the single balloon resulted in the least increase in MR. The most common complication of PMV is the increase in the degree of MR.

Prospective Assessment of the Diagnostic Accuracy of Instantaneous Wave-Free Ratio to Assess Coronary Stenosis Relevance: Results of ADVISE II International, Multicenter Study (ADenosine Vasodilator Independent Stenosis Evaluation II).

OBJECTIVES: The purpose of this study was to assess the diagnostic accuracy of the instantaneous wave-free ratio (iFR) to characterize, outside of a pre-specified range of values, stenosis severity, as defined by fractional flow reserve (FFR) ≤0.80, in a prospective, independent, controlled, core laboratory-based environment. BACKGROUND: Studies with methodological heterogeneity have reported some discrepancies in the classification agreement between iFR and FFR. The ADVISE II (ADenosine Vasodilator Independent Stenosis Evaluation II) study was designed to overcome limitations of previous iFR versus FFR comparisons. METHODS: A total of 919 intermediate coronary stenoses were investigated during baseline and hyperemia. From these, 690 pressure recordings (n = 598 patients) met core laboratory physiology criteria and are included in this report. RESULTS: The pre-specified iFR cut-off of 0.89 was optimal for the study and correctly classified 82.5% of the stenoses, with a sensitivity of 73.0% and specificity of 87.8% (C statistic: 0.90 [95% confidence interval (CI): 0.88 to 0.92, p < 0.001]). The proportion of stenoses properly classified by iFR outside of the pre-specified treatment (≤0.85) and deferral (≥0.94) values was 91.6% (95% CI: 88.8% to 93.9%). When combined with FFR use within these cut-offs, the percent of stenoses properly classified by such a pre-specified hybrid iFR-FFR approach was 94.2% (95% CI: 92.2% to 95.8%). The hybrid iFR-FFR approach obviated vasodilators from 65.1% (95% CI: 61.1% to 68.9%) of patients and 69.1% (95% CI: 65.5% to 72.6%) of stenoses. CONCLUSIONS: The ADVISE II study supports, on the basis rigorous methodology, the diagnostic value of iFR in establishing the functional significance of coronary stenoses, and highlights its complementariness with FFR when used in a hybrid iFR-FFR approach. (ADenosine Vasodilator Independent Stenosis Evaluation II-ADVISE II; NCT01740895).