Surgery of rheumatic mitral stenosis: comparison of different techniques.

Objective - The breakthrough of percutaneous transvenous mitral commissurotomy (PTMC) has dramatically changed the indications for the surgical treatment of rheumatic mitral stenosis over the last decade. No recent studies comparing long-term results of PTMC, open mitral commissurotomy (OMC) and mitral valve replacement (MVR) with bileaflet prostheses are available in medical literature. Methods and results - Between January 1991 and December 1997, 313 patients with 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 three groups of patients. No cases of hospital mortality were observed in the patients who underwent PTMC and OMC, whereas two patients (1.6%) died within 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 at 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are the first option to consider in treating mitral valve stenosis, valve replacement with bileaflet prostheses no longer represents a limiting factor to survival and quality of life.