Open mitral commissurotomy provided similar long-term composite outcomes to mechanical mitral valve replacement (36.9% vs 44.6%; sHR 0.78; 95% CI 0.42-1.45; P=.429) with fewer bleeding events.
Cohort (n=249)
Does open mitral commissurotomy improve long-term outcomes compared to mechanical mitral valve replacement in patients with severe rheumatic mitral stenosis?
Open mitral commissurotomy provides comparable long-term clinical outcomes to mechanical MVR in severe rheumatic mitral stenosis, with significantly lower risks of major bleeding and infective endocarditis.
Effect estimate: sHR 0.78 (95% CI 0.42-1.45)
Absolute Event Rate: 36.9% vs 44.6%
p-value: p=.429
BACKGROUND Mechanical mitral valve replacement (MVR) is widely performed for severe rheumatic mitral stenosis (MS) but requires lifelong anticoagulation and carries prosthesis-related risks. Open mitral commissurotomy offers a valve-preserving alternative, yet contemporary long-term data are scarce. We compared long-term outcomes of open mitral commissurotomy and MVR in severe MS. METHODS We retrospectively analyzed 249 patients undergoing mitral valve surgery for severe rheumatic MS (1995-2021): open mitral commissurotomy (n=58) and MVR (n=191). The primary outcome was a composite of all-cause death, mitral valve reoperation, major bleeding, stroke, heart failure readmission, and infective endocarditis. Propensity score matching adjusted for baseline differences. RESULTS Mean follow-up was 11.4±7.0 years. In the matched cohort, 20-year composite outcome incidence was similar between open mitral commissurotomy and MVR (36.9% vs. 44.6%; sHR 0.78; 95% CI 0.42-1.45; P=.429). Major bleeding was lower with open mitral commissurotomy (4.4% vs. 22.5%; sHR 0.22; P=.047), and infective endocarditis occurred only after MVR (0% vs. 2.4%). Mitral valve reoperation tended to be more frequent in the open mitral commissurotomy group (16.7% vs. 5.7%; sHR 3.04; P=.137), but the difference was not statistically significant. In open mitral commissurotomy, mitral valve area increased from 0.90±0.14 cm2 preoperatively to 1.56±0.31 cm2 at 15 years (P<.001), and transmitral pressure gradient decreased from 11.4±7.3 to 4.6±1.9 mmHg (P<.001). CONCLUSIONS In patients with severe MS, open mitral commissurotomy provides comparable long-term clinical outcomes to MVR and is associated with fewer bleeding and no infective endocarditis. These findings support open mitral commissurotomy as a reasonable valve-preserving option in selected patients.
Park et al. (Sun,) conducted a cohort in Severe rheumatic mitral stenosis (n=249). Open mitral commissurotomy vs. Mechanical mitral valve replacement (MVR) was evaluated on Composite of all-cause death, mitral valve reoperation, major bleeding, stroke, heart failure readmission, and infective endocarditis (sHR 0.78, 95% CI 0.42-1.45, p=.429). Open mitral commissurotomy provided similar long-term composite outcomes to mechanical mitral valve replacement (36.9% vs 44.6%; sHR 0.78; 95% CI 0.42-1.45; P=.429) with fewer bleeding events.