What are the indications for mitral valve replacement?

Conservative approach to the treatment of mixed mitral valve disease

Belcher, J. R. (1973). Thorax, 28, 608-612. Conservative approach to the treatment of mixed mitral valve disease. One hundred patients with mixed mitral valve disease have been treated with the `stand-by' bypass principle. In 59 the valve was replaced; in 41 a closed transventricular valvotomy was done. The results in the two groups have been compared.

The operative mortality for valvotomy was 7%; for valve replacement 20%. Late death occurred in 14% after valvotomy; in 25% after replacement. `Good' results were achieved in 49% after valvotomy; in 41% after replacement. Among the survivors 61% had `good' results after valvotomy as against 75% after replacement. Late emboli occurred in one patient after valvotomy; in 11 after replacement. Methods for improved selection of patients for simple valvotomy are discussed.

Valvotomy in calcific mitral stenosis

The results of transventricular mitral valvotomy in 50 cases of heavily calcified mitral stenosis are presented. The mortality and quality of results in patients undergoing a first valvotomy were more satisfactory than in patients undergoing a second operation. Associated mitral incompetence has an adverse effect on the results, particularly after a second operation. As a result, it is suggested that closed valvotomy, in these circumstances, is only acceptable for patients who are undergoing a first operation and who have minimal or no regurgitation. Valve replacement is advised for all other cases.