Late Results after Tubbs Closed Mitral Commissurotomy

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