Open mitral commissurotomy. A new plea for an old operation

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Disease
• Thoracic Surgery

Background:

• Isolated mitral valvular disease affects numerous patients requiring surgical intervention.
• Valve replacement (mechanical or bioprosthetic) and reconstructive repair are primary treatment options.
• Open mitral commissurotomy is a reconstructive option for specific patient subsets.

Purpose of the Study:

• To compare the long-term outcomes of open mitral commissurotomy versus mitral valve replacement.
• To evaluate mortality rates and survival curves for these distinct surgical approaches.
• To determine the efficacy of mitral commissurotomy in patients with suitable valve morphology.

Main Methods:

• Retrospective analysis of 127 patients undergoing open mitral commissurotomy (1974-1982).
• Comparison with historical data of 507 patients who underwent mitral valve replacement.
• Actuarial analysis of survival and complication rates.

Main Results:

• Open mitral commissurotomy had a low cardiac-related mortality of 1.5% (2 deaths).
• Thromboembolic complications occurred in 5 patients without permanent neurological deficits.
• Long-term survival analysis indicated superiority of commissurotomy over valve replacement when morphology is suitable.

Conclusions:

• Open mitral commissurotomy is a superior treatment option for selected patients with mitral valvular disease.
• This technique offers better long-term survival and reduced mortality compared to valve replacement.
• Careful patient selection based on valvular morphology is crucial for optimal outcomes.