[Salvage heart surgery after percutaneous mitral valvuloplasty]

Percutaneous mitral valvuloplasty (PMV) for selected patients with symptomatic mitral stenosis (MS) has been proposed as a safe alternative to open mitral commissurotomy (OMC) or mitral valvular replacement (MVR). Among 146 consecutive patients undergoing PMV from March 1987 to April 1990, 18 (12%) needed urgent (8) or delayed (10) (average 7 days) corrective surgery following PMV. There were 15 women and 3 men, with a clinical incapacity class II (3) or III (15), and with an intermediate risk for PMV according to echo score (mean = 8). The indications for corrective surgery were: massive mitral regurgitation due to tearing of the anterior leaflet (6), cardiac perforations (left atrium in 2, left ventricle in 3), PMV technical failure (5), severe atrial shunting (2). Operative procedures included MVR (14), cardiac wound suturing only (3), OMC (1). Operative mortality (30 days) was 22% (4/18), equally distributed among the urgent and delayed group. The causes of postoperative death were hemorrhage (2), severe cerebral ischemia (1) and sudden death (1). Compared to operative mortality after OMC (0/17.0%) or MVR (1/32, 3.1%) as the initial treatment for MS during the same time period, cardiac operation after failed or complicated PMV carried a significantly higher mortality (p = 0.004). Therefore, optimal patient selection and aggressive corrective surgery are necessary to decrease the PMV related mortality and morbidity.