Surgery of rheumatic mitral stenosis: comparison of different techniques

Objective-The breakthrough of percutaneous transvenous mitral commissurotom y (PTMC) has dramatically changed the indications for the surgical treatmen t of rheumatic mitral stenosis over the last decade. No recent studies comp aring long-term results of PTMC, open mitral commissurotomy (OMC) and mitra l valve replacement (MVR) with bileaflet prostheses are available in medica l literature. Methods and results-Between January 1991 and December 1997, 313 patients wi th pure and isolated rheumatic stenosis were treated in our department. One hundred and eleven patients underwent PTMC, 82 OMC and 120 MVR. There was no statistical difference (p > 0.05) between the mortality rates of the thr ee groups of patients. No cases of hospital mortality were observed in the patients who underwent PTMC and OMC, whereas two patients (1.6%) died withi n 30 days after MVR, Seven year actuarial survival results are: 95.41 +/- 2 (SE)% (PTMC), 98.05 +/- 1% (OMC) and 92.82 +/- 33% (MVR) (p = NS). Freedom from embolism was 98.78 +/- 1% in PTMC, 98.78 +/- 1% in OMC and 92.52 +/- 2 % in MVR (p > 0.05); freedom from reoperation was 88.43 +/- 8% in PTMC, 96. 35% +/- 2% in OMC and 97.72 +/- 1% in MVR (p > 0.05). The mean NYHA class a t the end of follow-up was lower in OMC (1.14 +/- 0.3) versus PTMC (1.39 +/ - 0.6) and MVR (1.41 +/- 0.71) (p = 0.001). Conclusions-Even though conservative techniques are the first option to con sider in treating mitral valve stenosis, valve replacement with bileaflet p rostheses no longer represents a limiting factor to survival and quality of life.