A comparison of repair and replacement for mitral stenosis with partially calcified valve.

From January 1978 to December 1987 we operated on 135 patients with calcified mitral stenosis. In 60 patients a conservative operation was performed (group I). Nine patients required mitral annuloplasty associated with the commissurotomy. The other 75 patients underwent mitral valve replacement (group II). In 37 patients a mechanical prosthesis was used and in 38 a biologic one. The patients given mitral valve replacement had a more heavily calcified valve than those undergoing a conservative procedure. Twenty-one patients (12 from group I and 13 from group II) required associated tricuspid annuloplasty. The mean follow-up time was 69.1 months (1 months to 10 years). There were no significant differences between the two groups in terms of operative death (0% and 4%, respectively), postoperative functional class, actuarial survival rate at 10 years (84% and 96%, respectively), and probability of freedom from thromboemboli at 10 years (98% and 96%, respectively). However, the probability of freedom from reoperation at 10 years significantly favored the conservative surgery group (84% and 69%, respectively, p less than 0.01). Finally, the probability of freedom from complications at 10 years was also significantly higher in the conservative surgery group (82% and 64%, respectively, p less than 0.005). Because of these results we believe that conservative surgery is, at present, a better alternative than mitral valve replacement for patients with partially calcified mitral stenosis.