Lithotripsy-Facilitated or Conventional Percutaneous Mitral Balloon Valvuloplasty for Calcific Mitral Valve Disease: A Systematic Review

Background: The efficacy of percutaneous mitral balloon valvuloplasty (PMBV) for mitral stenosis (MS) secondary to mitral annular calcification (MAC) is poorly understood. The purpose of this systematic review was to consolidate existing data on conventional and lithotripsy-facilitated PMBV in patients with calcific mitral valve disease, to better understand procedural outcomes. Methods: We performed a systematic search of the literature published in PubMed and Scopus databases through May 2024. We included all studies that reported outcomes of conventional PMBV as a standalone therapy or lithotripsy-facilitated mitral intervention for calcific mitral valve disease. Results: A total of 12 reports met the criteria for inclusion (8 lithotripsy and 4 conventional PMBV), including 4 case series and 8 case reports. Conventional PMBV (n = 44) procedural success in MAC was variable and associated with a limited reduction in mitral gradient in most patients. After conventional PMBV, 4 (9.1%) patients had moderate-to-severe mitral regurgitation (MR) or more, and 6 (13.6%) required mitral re-intervention. On the contrary, lithotripsy-facilitated PMBV for MAC (n = 40) led to hemodynamic improvement in most cases with a mean reduction of 5 to 8 mm Hg in mean mitral gradient. One case (2.5%) developed increased MR from baseline, and 1 (2.5%) required mitral reintervention. Outcomes beyond 3 months were lacking and precluded assessment on whether these improvements are sustained. Conclusions: This systematic review suggests that lithotripsy-facilitated PMBV for MAC-related MS is feasible and may offer favorable short-term outcomes compared with conventional PMBV alone. These findings highlight the need for larger, multicenter studies with longer follow-up.