Summary
At present, the closed transventricular mitral commissurotomy with the Tubbs dilator
is a controversial procedure. Its critics charge unsatisfactory results and early
reoperations. The risk associated with open mitral commissurotomy, however, may well
be higher than that associated with the closed procedure; mitral valve replacement
is also often necessary, even in pure mitral stenosis.
One hundred sixty-eight patients who underwent a Tubbs operation between 1970 and
1979 were surveyed at least one year, and an average of 4.5 years, after surgery.
Eight patients (4.8%) were lost to follow-up because they could not be located. Early
mortality was 3.0%; late mortality, 5.4% (9 patients died after the follow-up study
was concluded).The total reoperation rate was 4.1 %, i.e., 1.0% per patient year.
The survival rate was determined with the actuarial method of Berkson and Gage as modified by Anderson and co-workers. The 7-year survival rate was 91 % and the 10-year surival rate 84%.
This rate differs about as much from a normal population as the early mortality rate,
but it is considerably higher than that for a group of conservatively treated patients.
Thirty percent, or more, of the patients, had improved at least one class according
to the New York Heart Association Classification after 10 years; 15% slipped below
their preoperative class. Forty-two percent of the patients reported their condition
as still improved after 10 years; 26% considered their condition to have deteriorated.
The low reoperation rate, low early and late mortality, and the course described in
the present study justify continued use of the Tubbs closed mitral commissurotomy
with exact indication.
Key words
Closed mitral commissurotomy - Low early and late mortality - Favorable course - Good
late results - Exact indication
