EARLY OPEN MITRAL COMMISSUROTOMY - LONG-TERM RESULTS

It has frequently been suggested that early mitral commissurotomy coul d improve long-term results in patients with severe mitral stenosis. H owever, the real advantages of this procedure have yet to be demonstra ted. To evaluate this hypothesis, we retrospectively studied 397 patie nts who underwent operation for mitral stenosis in our unit between 19 78 and 1988. Forty of these patients (group I) fulfilled the criteria for early mitral commissurotomy: being young (average age 33 years), b eing asymptomatic or showing few symptoms, and being in sinus rhythm. The remaining 357 patients who underwent operation during the same per iod of time served as control (group II). Mitral valve replacement (p < 0.05) and associated tricuspid annuloplasty (p < 0.05) occurred less frequently in patients from group I than it did in patients from grou p II. Survival after 11 years for patients with early mitral commissur otomy was 100%, 90% of whom were in functional class I, were in sinus rhythm, and were receiving no medication whatsoever. Ninety-six percen t of these patients were free of complications after 11 years, compare d with 73% of patients in group II (p < 0.05). In our opinion, these r esults support the use of early mitral commissurotomy for young patien ts in sinus rhythm, who are symptom free, who are and who have a mitra l valve area is 1.3 cm2 or less.