Long-term results of mitral commissurotomy
| Autor: | Alessandro Mazzucco, Aldo Milano, Dino Casarotto, Paola Melacini, Carla Villanova, Francesco Campanile, D. Scalia, Giuseppe Fasoli, Giulio Rizzoli |
|---|---|
| Rok vydání: | 1993 |
| Předmět: |
Adult
Male Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Percutaneous Adolescent Postoperative Complications Mitral valve stenosis Mitral valve medicine Humans Mitral Valve Stenosis Cardiac Surgical Procedures Aged business.industry Age Factors Perioperative Middle Aged medicine.disease Echocardiography Doppler Confidence interval Surgery Survival Rate Stenosis medicine.anatomical_structure Echocardiography Multivariate Analysis Female Cardiology and Cardiovascular Medicine Commissurotomy business Mitral commissurotomy Follow-Up Studies |
| Zdroj: | Scopus-Elsevier |
| ISSN: | 0022-5223 |
| Popis: | Between January 1968 and December 1989, 280 patients underwent conservative surgical treatment for pure mitral stenosis. Closed commissurotomy was utilized in 134 patients, with a mean age of 38 +/- 11 years and a mean valve area of 1.0 +/- 0.29 cm2. Open commissurotomy was performed in 146 older patients (mean age 44 +/- 11 years) with a mean valve area of 0.9 +/- 0.3 cm2. The perioperative mortality was 3% in closed procedures and 3.4% in open procedures. Surviving patients were evaluated by questionnaires or phone interviews, and 129 patients were examined by two-dimensional echocardiography with the purpose of analyzing long-term results. Follow-up was 95% complete (Grunkemeier-Starr method), with a median of 18 years in patients with closed commissurotomy and 6.6 years in patients with open commissurotomy. The actuarial survival at 21 years was 60.8% (70% confidence limits 55% to 66%) in patients having closed commissurotomies and 60.6% (70% confidence limits 49% to 71%) at 22 years in patients having open commissurotomies. The "effective palliation" rate, defined by clinical and echocardiographic criteria, was 47% at 15 years and 15% at 20 years. We conclude that mitral commissurotomy is the procedure of choice in pure mitral valve stenosis and should be applied early. When performed in patients aged less than 40 years, a 78% (70% confidence limits 72% to 84%) survival at 18 years and 67% "effective palliation" at 15 years were observed. The closed valvotomy results of our study support the present trend toward use of percutaneous balloon valvotomy. |
| Databáze: | OpenAIRE |
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