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J Thorac Cardiovasc Surg. 2012 Apr;143(4 Suppl):S96-8. doi: 10.1016/j.jtcvs.2011.09.064. Epub 2011 Nov 1.

Long-term (≤ 50 years) results of patients after mitral valve commissurotomy--a single-center experience.

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Department of Cardiovascular Surgery, Ludwig-Maximilians-University Munich, Munich, Germany.



Currently, in Middle Europe, closed and open mitral valve commissurotomy (MVC) is rarely done and has been replaced by catheter-based balloon procedures. Especially under these circumstances, data on the long-term outcomes after surgical interventions are important.


From 1955 to 1989, 268 patients (75 male and 193 female patients) with mostly rheumatic or infectious mitral stenoses underwent closed (n = 151) or open (n = 117) surgical procedures. The mean age at surgery was 41.2 ± 11.1 years; 19 patients (7.1%) died within the first 30 days after surgery.


The 50-year follow-up was complete for 215 patients (80.2%). The survival rate at 10, 20, and 30 years after surgery was 80.2%, 58.6%, and 41.8%, respectively. The differences after closed and open MVC were nonsignificant. At the latest follow-up, 32 patients were alive and had a mean New York Heart Association functional classification of 2.7. The 10-, 20-, and 30-year freedom from reoperation rate was 93.2%, 82.9%, and 76.0% for the closed intervention group and 88.5%, 80.3%, and 78.7% for the open intervention groups. Again, the differences were nonsignificant. The main cause for reoperation was recurrent fibrosis of the mitral valve. Most patients (n = 51) received mechanical valves, 5 a bioprothesis, and 8 repeat MVC. Four patients required a third intervention.


In Middle Europe, closed and open MVCs are now rarely performed, but the ultra-long-term results are excellent and serve as a standard for the now-established balloon valvuloplasty. MVCs remain an option for pregnant women. In third world clinical conditions, closed MVC remains a less expensive alternative.

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