Open mitral commissurotomy. A new plea for an old operation.

From April 1974 through December 1982, 673 patients underwent surgery for isolated mitral valvular disease. Valve replacement was mandatory in 507 patients; of these, 255 received low-profile mechanical (mainly Björk-Shiley) prostheses and 252 bioprostheses. In 166 patients the mitral valve was amenable to reconstructive repair. This analysis is concerned exclusively with a subset of 127 patients, in whom open mitral commissurotomy was carried out (104 females and 23 males with a mean age at the time of operation of 45.5 years). There were 2 postoperative deaths, both due to intractable arrhythmias: one on the 4th postoperative day and one 6 years after surgery, giving a cardiac-related mortality of 1.5%. Thromboembolic complications were observed in 5 patients, none of whom developed permanent neurological deficits. There were 2 non-cardiac-related deaths: one of cancer and one of viral pneumonia. Mitral valve replacement was subsequently required in 2 patients at 2 and 7 years, respectively, after commissurotomy. Surgical intervention is pending for 2 further patients who appear likely to require valve replacement. Based on actuarial curves, the analysis of these results shows that, provided valvular morphology is suitable, open mitral commissurotomy is superior to valve replacement with respect to mortality rate and long-term survival.