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Scalia, Domenico; Rizzoli, Giulio; Campanile, Francesco; Melacini, Paola; Villanova, Carla; Milano, Aldo; Fasoli, Giuseppe; Mazzucco, Alessandro; Casarotto, Dino
The Journal of thoracic and cardiovascular surgery, 04/1993, Volume: 105, Issue: 4Journal Article
Between January 1968 and December 1989, 280 patients underwent conservative surgical treatment for pure mitral stenosis. Closed commissurotomy was utilized in 134 patients, with a mean age of 38 ± 11 years and a mean valve area of 1.0 ± 0.29 cm2. Open commissurotomy was performed in 146 older patients (mean age 44 ± 11 years) with a mean valve area of 0.9 ± 0.3 cm2. The perioperative mortality was 3% in closed procedures and 3.4% in open procedures. Surviving patients were evaluated by questionnaires or phone interviews, and 129 patients were examined by two-dimensional echocardiography with the purpose of analyzing long-term results. Follow-up was 95% complete (Grunkemeier-Starr method), with a median of 18 years in patients with closed commissurotomy and 6.6 years in patients with open commissurotomy. The actuarial survival at 21 years was 60.8% (70% confidence limits 55% to 66%) in patients having closed commissurotomies and 60.6% (70% confidence limits 49% to 71%) at 22 years in patients having open commissurotomies. The “effective palliation” rate, defined by clinical and echocardiographic criteria, was 47% at 15 years and 15% at 20 years. We conclude that mitral commissurotomy is the procedure of choice in pure mitral valve stenosis and should be applied early. When performed in patients aged less than 40 years, a 78% (70% confidence limits 72% to 84%) survival at 18 years and 67% “effective palliation” at 15 years were observed. The closed valvotomy results of our study support the present trend toward use of percutaneous balloon valvotomy.
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