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Open mitral commissurotomy: long-term results with echocardiographic correlation
Insights
Open mitral commissurotomy is a safe and effective procedure for isolated mitral stenosis, with high survival and good functional outcomes. Echocardiography can predict successful outcomes based on mitral valve area.
Area of Science:
- Cardiology
- Cardiac Surgery
- Echocardiography
Background:
- Mitral stenosis is a significant valvular heart disease.
- Open mitral commissurotomy is a primary surgical treatment option.
- Long-term outcomes and predictors of success require further investigation.
Purpose of the Study:
- To evaluate the long-term outcomes of open mitral commissurotomy for isolated mitral stenosis.
- To identify factors influencing survival and functional status post-procedure.
- To assess the correlation between echocardiographic mitral valve area and clinical outcomes.
Main Methods:
- Retrospective analysis of 91 patients undergoing open mitral commissurotomy over 11 years.
- Follow-up ranging from one to nine years (average: five years).
- Assessment of perioperative mortality, actuarial survival, functional class (NYHA FC), embolic events, reoperations, and complication-free status.
- Echocardiographic measurements of mitral orifice area in a subset of patients.
Main Results:
- Perioperative mortality was 4.4%.
- Actuarial survival was 94% at 5 years.
- 79% of patients achieved NYHA FC I or II at follow-up.
- 76% were complication-free at 5 years.
- Mitral orifice area ≥ 2 cm² on echocardiography correlated with good functional outcomes (FC I).
Conclusions:
- Open mitral commissurotomy offers favorable long-term survival and functional improvement in isolated mitral stenosis.
- Age, sex, prior commissurotomy, and surgical technique did not significantly impact outcomes.
- Echocardiographic mitral valve area is a reliable predictor of successful surgical results.
Abstract:
Over 11 years, 91 patients with isolated mitral stenosis underwent open mitral commissurotomy. Twenty-nine were 50 or more years old; 15 had had prior commissurotomies. Four (4.4%) died perioperatively; 87 were followed for one to nine years (average: five years). Overall actuarial survival was 94% at 5 years. Sixty-nine patients (79%) were NYHA Functional Class (FC) I or II at latest follow-up. Arterial embolism occurred in five patients; 14 patients (16%) had a second valve operation. Patients who remain in FC I or II and who are free of embolism and reoperation are classified as complication-free. Actuarial analysis demonstrated 76% to be so classified at five years after operation. Actuarial curves show that age older than 40 years, sex, previous commissurotomy, and "radical" versus simple open mitral commissurotomy did not influence survival or the incidence of good results. Follow-up M-mode and 2D echocardiograms were obtained in 42 patients. The estimated mitral orifice accurately separated FC I patients (orifice equal to or larger than 2 cm2) from FC II and FC III patients (orifice smaller than 2 cm2), and showed that echocardiographic evidence of a 2 cm2 or larger mitral orifice correlates with a good result.