Early Open Radical Commissurotomy: Surgical Treatment of Choice for Mitral Stenosis

Abstract

Between 1967 and 1979, 411 patients underwent surgical treatment of isolated mitral stenosis at our institution. Open radical mitral commissurotomy was performed in 150 patients (1967–1978; mean follow-up, 46 months; range, 4 to 116 months). Mitral valve replacement using a porcine prosthesis was performed in 74 patients (1976–1979; mean follow-up, 23 months; range, 2 to 48 months). Mitral valve replacement with a cloth-covered Starr-Edwards prosthesis was performed in 187 patients (1967–1975; mean follow-up, 45 months; range, 2 to 106 months). Preoperative characteristics were similar in the three groups. The open commissurotomy and Starr-Edwards groups were followed up to 9 years and the porcine valve group up to 4 years, with 97% follow-up in each group. Life-table analysis (6-month intervals) of all postoperative complications revealed significantly greater complication-free survival for patients who had open radical commissurotomy compared with Starr-Edwards ( p < 0.05) valve replacement. Similar analysis of thromboembolic and warfarin-related complications revealed significantly fewer complications in commissurotomy patients. No significant differences were found ( p > 0.05) when comparing the need for subsequent reoperation in each group. Operative mortality following open radical mitral commissurotomy (0%; 0 out of 150) was significantly less ( p < 0.05) than after mitral valve replacement in both porcine (8.1%; 6 out of 74) and Starr-Edwards (11.2%; 21 out of 187) groups. Life-table analysis of late cardiac-related mortality revealed a significantly greater cumulative survival rate for the commissurotomy versus the Starr-Edwards groups at all intervals from 12 to 108 months (100 versus 84 ± 5%, p < 0.05). No significant differences were noted between commissurotomy and porcine valve groups during the 4-year follow-up period (100 ± 0% versus 96 ± 3%, p > 0.05). Based on these findings, we conclude that when the anatomy is favorable, the surgical treatment of choice for isolated mitral stenosis is open radical mitral commissurotomy.