Hemodynamic Evaluation and Exercise Tolerance Comparison before and after Operation in Closed versus Open Mitral Valvotomy in Pure Mitral Stenosis

Abstract

The relative merits and efficacy of open versus closed mitral valvotomy remains controversial. The purpose of this study was to compare improvement of the hemodynamic parameters and exercise tolerance capacity of the 2 operations in 59 patients with pure mitral stenosis in sinus rhythm. Patients were randomly assigned to 1 of 2 groups: 29 patients in group 1 were operated on with the closed technique and 30 patients in group 2 were operated by the open technique. Preoperatively, the hemodynamic parameters and exercise capacity were similar in the two groups. Cardiac catheterization and exercise treadmill test were performed on all patients before and 3 months after each operation. Hemodynamic parameters as well as exercise tolerance capacity were significantly improved by both open and closed valvotomy ( p < 0.0001). However, postoperatively the improvement in exercise capacity was similar in both groups ( p = NS) and there was no significant difference in hemodynamic parameters in both groups, except for reduction in pulmonary artery pressure and increment in cardiac output. Complication rates were similar in both groups, except for atrial arrhythmias, which were more common in group 2. This study suggested that the closed technique, when performed by experienced surgeons, achieved similar hemodynamic and functional results as the open method. It also has the potential advantage of cost savings in addition to avoiding the complications of cardiopulmonary bypass. It clearly has a place in properly selected patients with mitral stenosis.