Key result
Valve replacement for mitral stenosis was associated with 24% operative mortality, compared to 0% early mortality for closed commissurotomy and 10% for open commissurotomy.
Why the study?
What are the outcomes of different surgical approaches (closed commissurotomy, open commissurotomy, valve replacement) in patients with pure or predominant mitral stenosis?
Cohort (n=124)
What are the outcomes of different surgical approaches (closed commissurotomy, open commissurotomy, valve replacement) in patients with pure or predominant mitral stenosis?
In a historical cohort, closed commissurotomy offered excellent outcomes with no mortality for suitable mitral stenosis patients, whereas valve replacement carried high mortality but provided comparable benefits for survivors with more severe disease.
Answers are grounded in this paper and cite their sources.
Valve replacement's high mortality cautions against routine use in mitral stenosis; leaves open optimal approach without randomized confirmation.
Among 124 consecutive patients undergoing operation for pure or predominant mitral stenosis between 1964 and 1969, closed commissurotomy was carried out in 53 (43%). There were no early or late deaths, and the hemodynamic and symptomatic results of operation were excellent. In 51 (41%) of the patients, valvular anatomy was such that valve replacement proved necessary. As a group, these patients were more severely symptomatic preoperatively and had worse hemodynamics than patients in the closed-commissurotomy group. With replacement, operative (24%) and late (12%) mortality were high, but surviving patients enjoyed hemodynamic and symptomatic benefits comparable to those of the patients undergoing closed commissurotomy. In 20 patients whose preoperative clinical and hemodynamic characteristics were intermediate between those of the closed-commissurotomy and valve-replacement groups, open commissurotomy was performed. Early (10%) and late (5%) mortality were less than with mitral replacement, but in general hemodynamic and symptomatic benefits were modest.
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Mullin et al. (1972) conducted a cohort in Pure or predominant mitral stenosis (n=124). Valve replacement vs. Closed commissurotomy was evaluated on Operative/early mortality. Valve replacement for mitral stenosis was associated with 24% operative mortality, compared to 0% early mortality for closed commissurotomy and 10% for open commissurotomy.
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