Long-term follow-up of open commissurotomy versus bileaflet valve replacement for rheumatic mitral stenosis.
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.
Cotrufo
M
M
Department of Cardiac Surgery, Vincenzo Monaldi Hospital, Second University of Naples, Italy.
Renzulli
A
A
Vitale
N
N
Nappi
G
G
De Feo
M
M
Ismeno
G
G
Di Benedetto
B
B
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