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The Annals of Thoracic Surgery, Vol 55, 641-645, Copyright © 1993 by The Society of Thoracic Surgeons

ARTICLES

Open mitral commissurotomy: fourteen- to eighteen-year follow-up clinical study

JM Herrera, JL Vega, JM Bernal, JM Rabasa and JM Revuelta
Cardiovascular Surgery, Hospital Universitario Marques de Valdecilla, Universidad de Cantabria, Santander, Spain.

From May 1974 to December 1978, 159 patients with mitral stenosis underwent open mitral commissurotomy at our institution. Follow-up data were complete in 96.8%, with a mean follow-up of 13.7 years (range, 14 to 18 years). Preoperatively, most patients (n = 94) were in functional class III or IV. Valve calcification was found in 18 patients (11.3%), left atrial thrombosis was found in 21 (13.2%), and the subvalvular apparatus was affected in 105 (66%). When a residual insufficiency was detected during the operation, a mitral annuloplasty was performed (n = 43). There was one hospital death (0.6%) and 15 late deaths (9.5%). Actuarial survival at 15-year and 18-year follow-up is 89.4% +/- 3% and 75.2% +/- 10.8%. Fifteen patients (9.7%) had a thromboembolic episode 1 to 189 months after operation (mean, 104.3 months). Eleven patients (7%) required reoperation 3 to 183 months after operation (mean, 110.1 months). Freedom from reoperation at 18-year follow-up was 91.9% +/- 2.7%. Event-free actuarial survival at 15-year and 18-year follow-up was 73.4% +/- 4.2% and 54.3% +/- 10.5%. Most patients (n = 131) are in class I or II. Open mitral commissurotomy represents a safe surgical alternative for treating mitral stenosis, allowing a complete removal of atrial thrombosis if present. This long-term follow-up clinical study encourages us to persist in this successful surgical repair of mitral stenosis.

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