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Open mitral commissurotomy: the 'golden standard'
M J Antunes1, H Vieira, J Ferrão de Oliveira
1Cardiothoracic Surgery, University Hospital, Coimbra, Portugal.
The Journal of Heart Valve Disease
|August 18, 2000
Summary
Open mitral commissurotomy (OMC) offers superior long-term outcomes for mitral stenosis compared to percutaneous balloon mitral commissurotomy (PBMC). OMC provides durable valve area improvement and low complication rates, making it the preferred treatment.
Area of Science:
- Cardiology
- Cardiac Surgery
- Interventional Cardiology
Background:
- Rheumatic mitral valve stenosis is a significant cardiovascular condition.
- Percutaneous balloon mitral commissurotomy (PBMC) is an alternative to surgical commissurotomy.
- PBMC may lead to incomplete commissure separation and restenosis, making open mitral commissurotomy (OMC) a preferred method.
Purpose of the Study:
- To assess the long-term outcomes of open mitral commissurotomy (OMC).
- To compare the efficacy of OMC with percutaneous balloon mitral commissurotomy (PBMC).
Main Methods:
- A series of 100 open mitral commissurotomy (OMC) procedures were reviewed.
- Patients had a preoperative echocardiographic score ≤10.
- Clinical and echocardiographic follow-up was conducted after a mean of 8.5 years.
Main Results:
- Mean valve area increased significantly post-OMC and remained durable at long-term follow-up (2.37 cm² after 8.5 years).
- 81% of patients achieved a valve area >2.0 cm², with only 2 reoperations required.
- Late mortality was 4%, with 93% of patients in NYHA functional class I or II.
Conclusions:
- Open mitral commissurotomy (OMC) is the preferred treatment for mitral stenosis, regardless of valve pliability.
- OMC demonstrates superior medium- and long-term results compared to PBMC.
- Valve conservation is feasible even with moderate to severe calcification.