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Original article

Vol. 141 No. 1516 (2011)

Systematic comparison of the effectiveness of percutaneous mitral balloon valvotomy with surgical mitral commissurotomy

  • Q Zhao
  • X Hu
Cite this as:
Swiss Med Wkly. 2011;141:w13180


PRINCIPLES: Percutaneous mitral balloon valvotomy is increasingly being carried out on patients with pure mitral stenosis, but discrepant results are still available at long-term follow-ups following percutaneous balloon and traditional surgical valvotomy. This research sought to systematically compare the efficacy and safety of mitral balloon and surgical valvotomy.

METHODS: A systematic literature retrieval was performed for all clinical trials comparing the outcomes of mitral valvotomy with balloon intervention or surgery in Pubmed, EMBASE and the Cochrane Library.

RESULTS: A total of 12 eligible, clinical studies, comparing mitral valvotomy using percutaneous balloon intervention or thoracotomy surgery, were found between 1966 and 2010: seven prospective randomised trials and five case-control trials. With follow-up ranging from one to seven years, there was no significant difference in mortality (relative risk (RR) 0.97, 95% confidence interval (CI) 0.45–2.09) and complications (RR 2.15, 95% CI 0.98–4.7) between the two procedures. The pooling analysis obtained a significantly higher occurrence of new-onset mitral regurgitation after percutaneous balloon intervention relative to thoracotomy surgery (RR 1.66 95%CI 1.08–2.58). Similarly, we obtained a higher RR of re-intervention in balloon intervention compared to thoracotomy surgery of 2.88 (95% CI 1.97–4.2). In addition, compared to those patients who had thoracotomy surgery, patients who underwent percutaneous balloon intervention presented a significantly worse effect in preserving the mitral valve area: SMD –0.30, 95%CI: –0.42 - –0.18.

CONCLUSIONS: Clinical evidence suggests there are comparable clinical outcomes in terms of operative, late mortality and complications between percutaneous balloon and surgical mitral commissurotomy. Incidences of new-onset mitral regurgitation and late re-intervention are significantly higher after balloon intervention.


  1. Carapetis JR, McDonald M, Wilson NJ. Acute rheumatic fever. Lancet. 2005;366:155–68.
  2. Inoue K, Owaki T, Nakamura T, Kitamura F, Miyamoto N. Clinical application of transvenous mitral commissurotomy by a new balloon catheter. J Thorac Cardiovasc Surg. 1984;87:394–402.
  3. Song JK, Kim MJ, Yun SC, Choo SJ, Song JM, Song H, et al. Long-term outcomes of percutaneous mitral balloon valvuloplasty versus open cardiac surgery. J Thorac Cardiovasc Surg. 2010;139(1):103–10.
  4. Cotrufo M, Renzulli A, Ismeno G, Caruso A, Mauro C, Caso P, De Simone L, Violini R. Percutaneous mitral commissurotomy versus open mitral commissurotomy: a comparative study. Eur J Cardiothorac Surg. 1999;15(5):646–51.
  5. Rifaie O, Abdel-Dayem MK, Ramzy A, Ezz-El-Din H, El-Ziady G, El-Itriby A, et al. Percutaneous mitral valvotomy versus closed surgical commissurotomy. Up to 15 years of follow-up of a prospective randomized study. J Cardiol. 2009;53(1):28–34.
  6. Jadad AR, Moore RA, Carroll D. Assessing the quality of reports of randomized clinical trials: is blinding necessary? Control Clin Trials. 1996;17:1–12.
  7. Clarke M,OxmanAD. Cochrane reviewer’s handbook 4.1.3 [updated June 2001]. In: The Cochrane Library, Issue 3: Oxford: Update Software, 2001.
  8. Cardoso LF, Grinberg M, Pomerantzeff PM, Rati MA, Medeiros CC, Vieira ML, et al. Comparison of open commissurotomy and balloon valvuloplasty in mitral stenosis. A five-year follow-up. Arq Bras Cardiol. 2004;83(3):248–52.
  9. Cardoso LF, Grinberg M, Rati MA, Pomerantzeff PM, Medeiros CC, Tarasoutchi F, Martinez E. Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis. A prospective and randomized study. Cardiology. 2002;98(4):186–90.
  10. Ismeno G, Renzulli A, De Feo M, Della Corte A, Mauro C, Romano G, Mininni N, Cotrufo M. Surgery of rheumatic mitral stenosis: comparison of different techniques. Acta Cardiol. 2001;56(3):155–61.
  11. Tokmakoglu H, Vural KM, Ozatik MA, Cehreli S, Sener E, Tasdemir O. Closed commissurotomy versus balloon valvuloplasty for rheumatic mitral stenosis. J Heart Valve Dis. 2001;10(3):281–7.
  12. Ommen SR, Nishimura RA, Grill DE, Holmes DR Jr, Rihal CS. Comparison of long-term results of percutaneous mitral balloon valvotomy with closed transventricular mitral commissurotomy at a single North American Institution. Am J Cardiol. 1999;84(5):575–7.
  13. Cardoso LF, Rati MA, Pomerantzeff PM, Medeiros CC, Tarasoutchi F, Rossi EG, et al. Comparison between percutaneous balloon valvuloplasty and open commissurotomy for mitral stenosis [Article in Portuguese] Arq Bras Cardiol. 1998;70(6):415–21.
  14. Ben Farhat M, Ayari M, Maatouk F, Betbout F, Gamra H, Jarra M, et al. Percutaneous balloon versus surgical closed and open mitral commissurotomy: seven-year follow-up results of a randomized trial. Circulation. 1998;97(3):245–50.
  15. Raju S Iyer, Rajnish Jain, Manoj Padmanabhan, Abha Chandra, Sanjeev Agarwal, et al. Closed Mitral Valvotomy Versus Balloon Valvuloplasty: A Comparison of 100 Cases. Asian Cardiovasc Thorac Ann. 1998;6:285–7.
  16. Essop R, Rothlisberger C, Dullabh A, Sareli P. Can the long-term outcomes of percutaneous balloon mitral valvotomy and surgical commissurotomy be expected to be similar? J Heart Valve Dis. 1995;4(5):446–52.
  17. Olmos A, Seguel I, Gajardo J, Ghyra A, Santander C, Alarcón E, et al. Percutaneous mitral valvuloplasty and open mitral commissurotomy: comparison of 2 techniques in immediate results [Article in Spanish] Rev Med Chil. 1994;122(3):274–82.
  18. Reyes VP, Raju BS, Wynne J, Stephenson LW, Raju R, Fromm BS, et al. Percutaneous balloon valvuloplasty compared with open surgical commissurotomy for mitral stenosis. N Engl J Med. 1994;331(15):961–7.
  19. Arora R, Nair M, Kalra GS, Nigam M, Khalilullah M. Immediate and long-term results of balloon and surgical closed mitral valvotomy: a randomized comparative study. Am Heart J. 1993;125(4):1091–4.
  20. Cohen JM, Glower DD, Harrison JK, Bashore TM, White WD, Smith LR, et al. Comparison of balloon valvuloplasty with operative treatment for mitral stenosis. Ann Thorac Surg. 1993;56(6):1254–62.
  21. Shrivastava S, Mathur A, Dev V, Saxena A, Venugopal P, SampathKumar A. Comparison of immediate hemodynamic response to closed mitral commissurotomy, single-balloon, and double-balloon mitral valvuloplasty in rheumatic mitral stenosis. J Thorac Cardiovasc Surg. 1992;104(5):1264–7.
  22. Momomura S, Takenaka K, Serizawa T, Chikada M, Kotsuka H, Matsunoga H, Furuse A. Percutaneous transvenous, mitral commissurotomy versus open mitral commissurotomy. [Article in Japanese] Nippon Geka Gakkai Zasshi. 1992;93(9):1016–9.
  23. Patel JJ, Shama D, Mitha AS, Blyth D, Hassen F, Le Roux BT, Chetty S. Balloon valvuloplasty versus closed commissurotomy for pliable mitral stenosis: a prospective hemodynamic study. J Am Coll Cardiol. 1991;18(5):1318–22.
  24. Turi ZG, Reyes VP, Raju BS, Raju AR, Kumar DN, Rajagopal P, et al. Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. A prospective, randomized trial. Circulation. 1991;83(4):1179–85.
  25. Kirklin JW. Percutaneous balloon versus surgical closed commissurotomy for mitral stenosis. Circulation. 1991;83(4):1450–1.
  26. Grinberg M, Bellotti G, Pileggi F. Aspectos do planejamento terapêutico na estenose mitral. Arq Bras Cardiol. 1983;51:289–95.
  27. Iung B, Garbarz E, Michaud P, Mahdhaoui A, Helou S, Farah B, et al. Percutaneous mitral commissurotomy for restenosis after surgical commissurotomy: late efficacy and implications for patient selection. J Am Coll Cardiol. 2000;35(5):1295–302.
  28. Essop R, Rothlisberger C, Dullabh A, Sareli P. Can the long term outcomes of percutaneous ballon mitral valvotomy and surgical commissurotomy be expected to be similar? J Heart Valve Dis. 1995;4:446±45
  29. Black MD, Campagna M, Bedard P, Marquis JF, Walley VM. Severe mitral insufficiency post-balloon valvuloplsty: The late changes found in a disrupted mitral valve. Cathet Cardiovasc Diagn. 1990;21:99–102.
  30. Acar C, Jebara VA, Grare P, Chachques JC, Dervanian P, Vahanian A, Carpentier A. Traumatic mitral insufficiency following percutaneous mitral dilation: anatomic lesions and surgical implications. Eur J Cardiothorac Surg. 1992;6(12):660–3.