Mitral Valve Repair Surgery (Commissurotomy) for Mitral Valve Stenosis
Commissurotomy is an open-heart surgery that repairs a mitral valve that is narrowed from mitral valve stenosis. It is also called open commissurotomy.
During this surgery, a person is put on a heart-lung bypass machine. The surgeon removes calcium deposits and other scar tissue from the valve leaflets. The surgeon may cut parts of the valve structure. This surgery opens the valve.
It is used for people who have severe narrowing of the valve and aren't good candidates for balloon valvotomy.
What To Expect After Surgery
Symptoms of mitral valve stenosis improve almost immediately after commissurotomy.1
You will feel tired and sore for the first few weeks after surgery. You may have some brief, sharp pains on either side of your chest. Your chest, shoulders, and upper back may ache. The incision in your chest may be sore or swollen. These symptoms usually get better after 4 to 6 weeks.
You will probably be able to do many of your usual activities after 4 to 6 weeks. But for at least 6 weeks, you will not be able to lift heavy objects or do activities that strain your chest or upper arm muscles. At first you may notice that you get tired easily and need to rest often. It may take 1 to 2 months to get your energy back.
Even though the surgery repaired your mitral valve, it is still important to eat a heart-healthy diet, get regular exercise, not smoke, take your heart medicines, and reduce stress. Your doctor may recommend that you work with a nurse, a dietitian, and a physical therapist to make these changes. This is sometimes called cardiac rehabilitation.
For more information, see Heart Valve Surgery: Recovery.
Call your doctor if symptoms return
If symptoms happen again after surgery, tell your doctor. You will be asked about your symptoms and will probably have tests to check your heart valves.
Sometimes these symptoms are due to the mitral valve narrowing again (restenosis). Restenosis might happen 1 to 2 years after treatment. But symptoms can also be caused by other valve, heart, or lung problems, especially when they develop long after your surgery..
Why It Is Done
Commissurotomy is used for people who have severe narrowing of the valve and aren't good candidates for balloon valvotomy. A commissurotomy is most often done if the mitral valve is very damaged or has a lot of calcium buildup.
Commissurotomy is not recommended if balloon valvotomy is an option to repair the mitral valve.
How Well It Works
About 80 to 90 out of100 people who have a commissurotomy surgery have successful outcomes and almost immediate symptom relief.1 Symptoms are relieved because the surgery opens the narrowed mitral valve, allowing blood to flow more easily through the heart.
After 5 years, about 4 to 7 people out of 100 need another mitral valve surgery.1
A commissurotomy surgery has the risks of any open-heart surgery with a heart-lung bypass. About 1 to 3 out of 100 people have a serious complication after surgery.1 The exact risks of surgery vary depending on the person's specific condition and general health prior to surgery.
Risks during surgery and soon after surgery. These risks include dangerous blood clots, bleeding, infection, and risks associated with anesthesia. About 1 out of 100 people die from this surgery.2
Risks after surgery. Complications that happen after surgery include:
- Mitral valve regurgitation. The valve might be damaged so that it doesn't close normally and allows blood to leak backward in the heart.
- Restenosis. The valve can become narrow again after 10 to 20 years. You may need another repair surgery or a valve replacement surgery.
What To Think About
Deciding whether you need treatment for mitral valve stenosis—and if so, when—is a major decision. To make this decision, you and your doctor will consider the severity of your mitral valve stenosis, the possibility that it will get worse, and the risks of surgery.
Although most people have successful outcomes from commissurotomy surgery, the risk of death and serious problems during surgery is real. It should be strongly weighed in the decision to replace your valve, particularly if you have other serious health issues.
For more information about valve repair and valve replacement options, see Mitral Valve Stenosis: Repair or Replace the Valve?
- Bonow RO, et al. (2008). 2008 Focused update incorporated into the ACC/AHA 2006 Guidelines for the management of patients with valvular heart disease: A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing committee to revise the 1998 Guidelines for the management of patients with valvular heart disease). Circulation, 118(15): e523–e661.
- Otto CM, Bonow RO (2012). Valvular heart disease. In RO Bonow et al., eds., Braunwald’s Heart Disease: A Textbook of Cardiovascular Medicine, 9th ed., vol. 2, pp. 1468–1539. Philadelphia: Saunders.
Last Revised: November 18, 2011
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