title: Long-term follow-up of open commissurotomy versus bileaflet valve replacement for rheumatic mitral stenosis.
abstract: OBJECTIVE
  Despite the achievements of third generation mechanical cardiac valve prostheses, conservative procedures are still considered the best surgical option for rheumatic mitral valve stenosis. To compare long-term results of open mitral commissurotomy (Group A) and mitral valve replacement with bileaflet prostheses (Group B) a 15-year follow-up study was carried out.
  
  
  METHODS
  From January 1981 to May 1996, 540 consecutive patients with pure isolated rheumatic mitral stenosis underwent mitral valve surgery: 300 had mitral commissurotomy and 240 valve replacement. The follow-up was 99.05% complete and ranged between 1 and 185 months in Group A and from 1 to 171 months in Group B.
  
  
  RESULTS
  Hospital mortality was 2% in Group A and 2.08% in Group B. Late mortality was 1% in Group A and 3% in Group B. The 10-year survival rates were 98.7% +/- 1% in Group A and 93.7% +/- 3% in Group B. There was a statistically significant difference of freedom from reoperation in Group B (97.7% +/- 1%) versus Group A (88.1% +/- 2%) (P = 0.04). In group A 14 embolic events occurred (93.7% +/- 2%), and 15 (6.52%) in Group B (83.9% +/- 7%). Haemorrhagic events were observed in 2 patients (0.68%) of Group A (99.3% +/- 0.5%) and in 3 patients (1.3%) of Group B (98.4% +/- 1%).
  
  
  CONCLUSIONS
  Long term results of mitral commissurotomy were more satisfactory than those obtained with bileaflet valves. Reoperation rate was higher in mitral commissurotomy.
authors.affiliation: Department of Cardiac Surgery, Vincenzo Monaldi Hospital, Second University of Naples, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Cotrufo
authors.forename: A
authors.initials: A
authors.lastname: Renzulli
authors.forename: N
authors.initials: N
authors.lastname: Vitale
authors.forename: G
authors.initials: G
authors.lastname: Nappi
authors.forename: M
authors.initials: M
authors.lastname: De Feo
authors.forename: G
authors.initials: G
authors.lastname: Ismeno
authors.forename: B
authors.initials: B
authors.lastname: Di Benedetto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004617:Embolism / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality / Q000592:standards*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008946:Mitral Valve Stenosis / Q000382:microbiology* / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D012086:Reoperation; D012214:Rheumatic Heart Disease / Q000150:complications*; D016019:Survival Analysis; D016896:Treatment Outcome