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Outcome probabilities and life history after surgical mitral commissurotomy: implications for balloon commissurotomy

M S Hickey1, E H Blackstone, J W Kirklin

  • 1Department of Surgery, University of Alabama, Birmingham School of Medicine 35294.

Journal of the American College of Cardiology
|January 1, 1991
PubMed

Insights

Surgical mitral commissurotomy offers excellent long-term survival for mitral stenosis patients. Initial closed or percutaneous balloon mitral commissurotomy is recommended, avoiding immediate risks associated with open techniques.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Interventional Cardiology

Background:

  • Mitral stenosis is a significant valvular heart disease.
  • Surgical commissurotomy has been a primary treatment modality.
  • Long-term outcomes comparing open and closed techniques require further analysis.

Purpose of the Study:

  • To evaluate the long-term survival and outcomes of surgical mitral commissurotomy.
  • To compare the efficacy and risks of open versus closed surgical techniques.
  • To identify risk factors for adverse outcomes after mitral commissurotomy.

Main Methods:

  • Retrospective analysis of 339 patients with mitral stenosis undergoing surgical commissurotomy (103 closed, 236 open) between 1967 and 1988.
  • Assessment of overall survival rates at various time points (1 month, 1, 5, 10, 20 years).
  • Analysis of risk factors for re-intervention, thromboembolism, functional status, and mitral incompetence.

Main Results:

  • Overall survival rates at 20 years were 59%.
  • Surgical technique (open vs. closed) was not a significant risk factor for survival, re-intervention, or thromboembolism.
  • Older age, black race, higher pulmonary vascular resistance, calcification, left ventricular enlargement, and post-commissurotomy mitral incompetence were identified as risk factors.
  • Mitral valve replacement was not required within 20 years for 47% of patients.

Conclusions:

  • Surgical closed or percutaneous balloon mitral commissurotomy is likely the preferred initial therapy for most mitral stenosis patients.
  • The study provides equations to predict and compare outcomes of percutaneous balloon commissurotomy, surgical commissurotomy, and mitral valve replacement.
  • Despite potential for mitral incompetence and future valve replacement, initial commissurotomy offers favorable long-term results.

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