Open mitral commissurotomy. A modern re-evaluation.

Familiarity with replacement of the mitral valve (MVR) with prosthetic and tissue valves has dimmed awareness of the usefulness of open mitral commissurotomy (OMC). This is a review of a 10 year experience ending in December, 1978, of 222 consecutive patients operated upon with a clinical diagnosis of pure mitral stenosis. MVR was necessary in 25 patients (11.3%), primarily because of severe deformity of valvular and subvalvular structures. No closed commissurotomies were performed, as that operation is now considered passé. Of the 197 patients undergoing OMC, 12 had additional cardiac procedures. Of the three patients who died (1.52%), two were operated upon on an emergency basis because of rapidly progressive cardiac failure. Follow-up data were obtained on 191 (97%) of the 197 OMC patients. There were 18 late deaths, of which 14 were related to cardiac disease. Following OMC, 76% (146) of the patients had improved by at least one New York Heart Association class. Fourteen (7%) of the 191 OMC patients had subsequent MVR at times varying from 2 to 92 months after OMC (mean 41.6 months). Ten-year survival for the 197 OMC patients was 81%. This clinical experience emphasizes that open commissurotomy rather than valve replacement is the best initial treatment for most patients with mitral stenosis.