Title : Open mitral commissurotomy in surgery of isolated mitral valve disease: Does the procedure have a long-term history?
Abstract:
Aim: To research possibilities of open mitral comissurothomy (OMC) in correction of mitral valve disease (MVD).
Materials: Analyzed group consists of 245 patients (pts) with MVD operated in Institute during period from 01.01.1981 till 01.01.2018. Average age was 53,3±7,4 yy. 151 (61,6%) pts belonged to IV NYHA class, 69 (28,2%) – to III and 25 (10,2%) pts to II. There were 79 (32,2%) males and 166 (67,8%) females. Mitral stenosis was in 211(86,1%) pts, combined MVD in 34 (13,9%) pts. Etiology of MVD was: rheumatism (72%), rheumatism+lipoidosis (23%), degenerative age changes (5%). MV calcinosis was in 17 (6,9%) pts. Isolated OMC was performed In 166 (67,7%) pts, in 79 (32,3%) cases – in combination with other plastic procedures on MV including ring annuloplasty, suture comissuroplasty, resection of posterior leaflet. Thrombectomy of left atrium was performed in 71 (30,2%) pts including 21(9,1%) pts with massive thrombus formation. 9 (4,0%) pts were cerebral cysts after previous episods of thromboemboli. Tricuspid valve correction was occured in 75 (30,7%) pts. Maze procedure were occurwd in 21 (8,5%) ptsAll operations were performed with cardiopulmonary bypass, moderate hypothermia and crystalloid cardioplegia. Average time of cardiopulmonary bypass was 60,4 ± 7,3 min, of cross-clamping - 48,3 ± 8,4 min. Average bloodless was 300-450 ml. Without using of donor blood 41(16,7%) operations were performed.
Results: Among 245 operated pts on hospital period (30 days after operation) 2 pts died (hospital mortality - 0,8%). Reasons of deaths: pneumonia (n=1), brain damage (n=1). Transient neurological complications were in 3 (1,3%) pts. During echocardiography on hospital stage gradient on MV was 5,7±0,7 mm Hg, regurgitation 1+ marked in 14 (5,7%) cases. Pts were discharged in average on 8,2±1,2 day after operation without clinically significant complications. In remote period 27,8±4,7 yy we follow-up 215 pts (88,4%of survival at hospital period). Good-satisfactory result was marked only at 19,4% of pts. 105 pts (48,8%) died. Reoperations were performed in 59 (27,4%) cases - MVR.
Conclusion: OMC is adequate method of surgical correction of MVD with minimal risk of developing of fatal complications only at the short remote period (average 10 years). Method is acceptable as isolated and in addition with ring annuloplasty, suture comissuroplasty. In case of small cavity of left ventricle OMC may be alternative to prosthesis, that allows to exclude possibility obstruction of outlet of left ventricle and also in pts with massive thromboses of LA that decreased level of thromboembolic events at remote period.
