OPEN MITRAL VALVOTOMY - EFFECT OF PREOPERATIVE FACTORS ON RESULT

  • 1 January 1981
    • journal article
    • research article
    • Vol. 82  (5) , 738-751
Abstract
Patients (154) who underwent open mitral valvotomy in 1968-1976 were reviewed 1-112 mo. (mean 48) postoperatively. There was 1 hospital death and 14 late deaths (9 cardiac), and 16 patients required reoperation during the follow-up period. Preoperative factors were examined to assess their association with an unsatisfactory postoperative course. End points included unsatisfactory symptomatic status, the need for reoperation and postoperative death. Maori race and atrial fibrillation (AF) were associated with all 3 end point. Other preoperative factors associated with at least 1 unfavorable end point were female sex, unfavorable preoperative symptomatic status, mild associated mitral incompetence (MI), a previous operation, and calcification in the mitral valve. The degree of subvalvular fusion and the adequacy of valvotomy assessed at operation were also related to outcome. A binary regression program was developed to assist in the prediction of outcome from an assessment of preoperative factors. Preoperative embolism occurred in 31 patients and postoperative embolism in 13. Postoperative embolism occurred in 35% of patients with a preoperative embolic episode and AF. Open mitral valvotomy carries a low operative risk, but unfavorable preoperative factors militate against a staisfactory long-term result and protection from recurrent embolism is only partial.