@

초록

Background Mechanical mitral valve replacement (MVR) is widely performed for severe rheumatic mitral stenosis (MS) but requires lifelong anticoagulation and carries prosthesis-related risks. Open mitral commissurotomy offers a valve-preserving alternative, yet contemporary long-term data are scarce. We compared long-term outcomes of open mitral commissurotomy and MVR in severe MS. Methods We retrospectively analyzed 249 patients undergoing mitral valve surgery for severe rheumatic MS (1995-2021): open mitral commissurotomy (n = 58) and MVR (n = 191). The primary outcome was a composite of all-cause death, mitral valve reoperation, major bleeding, stroke, heart failure readmission, and infective endocarditis. Propensity score matching adjusted for baseline differences. Results Mean follow-up was 11.4 ± 7.0 years. In the matched cohort, 20-year composite outcome incidence was similar between open mitral commissurotomy and MVR (36.9% vs 44.6%; subdistribution hazard ratio (sHR), 0.78; 95% CI, 0.42-1.45; P = .429). Major bleeding was lower with open mitral commissurotomy (4.4% vs 22.5%; sHR, 0.22; P = .047), and infective endocarditis occurred only after MVR (0% vs 2.4%). Mitral valve reoperation tended to be more frequent in the open mitral commissurotomy group (16.7% vs 5.7%; sHR, 3.04; P = .137), but the difference was not statistically significant. In open mitral commissurotomy, mitral valve area increased from 0.90 ± 0.14 cm2 preoperatively to 1.56 ± 0.31 cm2 at 15 years ( P < .001), and transmitral pressure gradient decreased from 11.4 ± 7.3 mm Hg to 4.6 ± 1.9 mm Hg ( P < .001). Conclusions In patients with severe MS, open mitral commissurotomy provides comparable long-term clinical outcomes to MVR and is associated with fewer bleeding events and no infective endocarditis. These findings support open mitral commissurotomy as a reasonable valve-preserving option in selected patients.