Long-term follow-up of open commissurotomy versus bileaflet valve replacement for rheumatic mitral stenosis

OBJECTIVE: Despite the achievements of third generation mechanical cardiac valve prostheses, conservative procedures are still considered the best surgical option for rheumatic mitral valve stenosis. To compare long-term results of open mitral commissurotomy (Group A) and mitral valve replacement with bileaflet prostheses (Group B) a 15-year follow-up study was carried out. METHODS: From January 1981 to May 1996, 540 consecutive patients with pure isolated rheumatic mitral stenosis underwent mitral valve surgery: 300 had mitral commissurotomy and 240 valve replacement. The follow-up was 99.05% complete and ranged between 1 and 185 months in Group A and from 1 to 171 months in Group B. RESULTS: Hospital mortality was 2% in Group A and 2.08% in Group B. Late mortality was 1% in Group A and 3% in Group B. The 10-year survival rates were 98.7% ± 1% in Group A and 93.7%± 3% in Group B. There was a statistically significant difference offreedom from reoperation in Group B (97.7% ± 1%) versus Group A (88.1%± 2%) (P = 0.04). In group A 14 embolic events occurred (93.7% ± 2%),and 15 (6.52%) in Group B (83.9% ± 7%). Haemorrhagic events were observed in 2 patients (0.68%) of Group A (99.3% ± 0.5%) and in 3 patients (1.3%) of Group B (98.4% ± 1%). CONCLUSIONS: Long term results of mitral commissurotomy were more satisfactory than those obtained with bileaflet valves. Reoperation rate was higher in mitral commissurotomy.