Percutaneous mitral commissurotomy versus open mitral commissurotomy: a comparative study

Area of Science:

• Cardiology
• Cardiac Surgery
• Interventional Cardiology

Background:

• Rheumatic mitral stenosis is a significant cause of cardiac morbidity.
• Percutaneous trans-septal mitral commissurotomy (PTMC) and open mitral commissurotomy (OMC) are established treatments.
• Long-term comparative data between PTMC and OMC are limited.

Purpose of the Study:

• To compare the long-term outcomes of PTMC and OMC in patients with isolated mitral stenosis.
• To evaluate survival, freedom from complications, and functional recovery after both procedures.

Main Methods:

• A prospective study comparing PTMC (n=111) and OMC (n=82) between 1991-1997.
• Patients were followed for long-term outcomes including survival and event-free analysis.
• Echocardiographic assessments were used to evaluate mitral valve area and recurrent stenosis.

Main Results:

• No significant difference in 7-year survival or freedom from late complications (embolism, recurrent stenosis, reoperation) between PTMC and OMC.
• OMC resulted in a significantly larger mitral valve area (2.05 vs 1.81 cm²) and better functional recovery (NYHA class 1.14 vs 1.39).
• Hospital mortality and complication rates were low and similar in both groups.

Conclusions:

• Both PTMC and OMC provide effective palliation for rheumatic mitral stenosis with low operative risk.
• OMC demonstrates advantages in achieving a larger mitral valve area and improved functional status post-procedure.
• Long-term complication incidence is comparable between the two techniques.