Percutaneous mitral commissurotomy versus open mitral commissurotomy: a comparative study

Objective: Although many studies in medical literature are comparing percut aneous trans-septal mitral commissurotomy (PTMC) and open mitral commissuro tomy (OMC), very few long-term comparative follow-ups are available. Method s: Between January 1991 and December 1997, 193 patients with isolated mitra l stenosis were assigned either to PTMC (111 cases) or to OMC (82 cases). P TMC was performed in all cases with Inoue Ballon, OMC was performed with st andard techniques. Categorial values were compared by chi square analysis, whereas continuous data were compared by Mann-Whitney test. Univariate surv ival and event free analysis (Kaplan-Meier +/- SE and log rank) were perfor med. Recurrent stenosis was classified any mitral valve area (MVA) less tha n 1.2 cm(2) and whenever post-op. echo showed a loss more than 50% of the i nitial gain. Data were reported as mean +/- SD. Data concerning late echoca rdiographic assessment were studied with linear and logistic regression ana lysis. Results: The two groups were homogenous as far preoperative variable s as sex, mean age, MVA, echo score and incidence of left atrial thrombosis were concerned. Mean NYHA was preoperatively higher in OMC (2.79 +/- 0.58) versus PTMC (2.42 +/- 0.5) (P = 0.001). There was no hospital mortality in both groups. Incidence of hospital complications was similar (4/ 111 after MMC and 1/82 after OMC; P = 0.3). Seven year survival: 95.41 +/- 0.02 (PTM C) and 98.05 +/- 0.01 (OMC) (P = 0.3) and freedom from late complications d id not show statistical differences: Embolism 98.78 +/- 0.01 in PTMC and 98 .78 +/- 0.01 in OMC (P = 0.8); Recurrent stenosis 71.89 +/- 0.13 in PTMC ve rsus 82.89 +/- 0.08 in OMC (P = 0.2); Reoperation 88.43 +/- 0.08 in PTMC ve rsus 96.25 +/- 0.02 in OMC (P = 0.4). A larger MVA was found in patients un dergone to OMC (2.05 +/- 0.35) versus PTMC (1.81 +/- 0.33) (P = 0.001). Fur thermore mean NYHA was lower in OMC (1.14 +/- 0.3) versus PTMC (1.39 +/- 0. 7) (P = 0.001), Conclusions: Both techniques achieve with a low operative r isk and low incidence of complications a good palliation of rheumatic mitra l stenosis. Incidence of complications in the follow-up is similar. OMC all ows a larger mitral valve area, a better functional recovery and a lower in cidence of late mitral regurgitation. (C) 1999 Published by Elsevier Scienc e Ireland Ltd. All rights reserved.