Late results following closed mitral valvotomy in isolated mitral valve stenosis: analysis of thirty-five years of follow-up in 240 patients using Cox regression.
Between 1950 and 1985, 240 patients (male/female ratio: 1/3.9, mean age 47.2 +/- 10.4 years [11-71]) with isolated mitral valve stenosis underwent closed mitral valvotomy (CMV). Ten hospital deaths (4.2%) were excluded from further analysis. Follow-up totaled 3,572 patient-years. Pre- and intraoperative predictability of long-term event-free (i.e. no reoperation) survival was examined using the Cox regression analysis. Six preoperative- and one intraoperative variables were found to have independent predictive value: mean pulmonary capillary wedge pressure (25 mmHg), age, congestive heart failure, sex, mean systemic blood pressure (116 mmHg), mitral opening snap, and postoperative regurgitation (judged intraoperatively). The Kaplan-Meier estimate of survival at 1-, 5-, 10-, 15-, 20-, 25-, 30 and 34 years +/- SE were 95 +/- 1%, 85 +/- 2%, 72 +/- 3%, 51 +/- 3%, 32 +/- 4%, 15 +/- 4%, 14 +/- 4%, and 9 +/- 5% respectively. NYHA functional class improved from a mean of 2.8 preoperatively to 1.7 at one year and 1.9 at 5-years. Long-term complications: thromboembolism of 0.67 per 100 patient-years; endocarditis of 0.47 per 100 patient-years. Reoperation was done on 28% with a hospital mortality of 6.3%. The time span from first CMV was mean 14.6 years (0.2-27.8). At reoperation 92% had stenosis, 81% regurgitation, and 8% endocarditis. In conclusion CMV offers good long-term palliation of symptoms from isolated mitral stenosis in patients without signs of irreversible organ damage and with pliable valves. The frequency of endocarditis and thromboembolic complications is low.(ABSTRACT TRUNCATED AT 250 WORDS)
Ravkilde
J L
JL
Department of Thoracic and Cardiovascular Surgery, Skjby Sygehus, Aarhus University Hospital, Denmark.
Hansen
P S
PS
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000601:surgery*; D010166:Palliative Care; D011183:Postoperative Complications; D011379:Prognosis; D012044:Regression Analysis; D012086:Reoperation / Q000401:mortality