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 70%; for valve replacement 20%. Late death occurred in 140% after valvotomy; in 250% 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 750% 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.