Cardiac Surgery for Acquired Valvular Disease: Modifications Experienced with 2,000 Cases

¹ Surgeon, Bailey Thoracic Clinic, and Hahnemann Hospital and Medical College, Philadelphia, Pa.
² Chief, Department of Cardiovascular Surgery, Harrisburg Hospital and Harrisburg Polyclinic Hospital.

Our experiences in the operative treatment of more than 2,000 patients with acquired valvular disease are presented. Recent modifications in surgical technique are described and their advantages outlined.

1. More adequate mobilization of the mitral valve leaflets has been attained when commissurotomy is done from the right thoracic approach. A bicommissural opening was attained in 97 per cent of those patients operated by the right sided approach, and only in 33 per cent of those explored through the left side.

2. Cross-polar plication of the valve annulus, as proposed by Nichols, provides effective relief of mitral regurgitation with a reduction in the mortality rate to 14 per cent.

3. A five and one-half to eight year follow-up was obtained in 200 mitral commissurotomies, and their present status reported.

4. The indications and the techniques for aortic commissurotomy are presented with a discussion of our results by the open technique.