Stentless Mitral Valve Implantation in Comparison to Conventional Mitral Valve Repair or Replacement at Five Years[*]

Abstract

Objective: A chordally supported stentless mitral valve (SMV) may be a suitable prosthesis for patients with severe degenerative mitral valve disease. We analyzed the five-year results and compared them with results after conventional mitral valve repair or replacement. Methods: 155 patients, operated on since August 1997, were evaluated. 53 patients (ages, 68 ± 8 years, 37 female, valve repair not feasible) received a SMV (Quattro^TM), 51 patients (69 ± 9 years, 32 female) had mitral valve repair (MVR) and 51 patients (66 ± 9 years, 32 female) had a conventional mitral valve replacement (MVP). There were no significant differences with respect to preoperative NYHA functional class, left ventricular ejection fraction, cardiac index and surgical risk, according to the EuroSCORE. Mean follow-up is 64 ± 18 (21 - 89) months. Results: Surgery was performed using a median sternotomy (32 [SMV]/20 [MVR]/34 [MVP]) or a lateral minithoracotomy 21/31/17 approach. The SMV was safely attached to the papillary muscles. In-hospital mortality was 1, 2 and 4 respectively; re-operation was required in 6, 2 and 3 patients. Five-year survival rate was 80.6 ± 4.4 % (SMV), 80.2 ± 5.6 % (CMV) and 82.6 ± 5.6 % (MVP), p = n.s. After hospital discharge, there was no significant difference in mortality in comparison to an age-matched control population. Echocardiography revealed acceptable SMV hemodynamics with preservation of left ventricular function. Conclusion: Midterm results after SMV implantation are comparable to conventional approaches. Complete preservation of the annulo-ventricular continuity is advantageous and close to physiologic hemodynamics can be achieved. Long term follow-up is required.

Key words

Mitral valve replacement - stentless bioprostheses - stentless mitral valve - mitral valve repair

1 Presented as a moderated poster at the 4th joint meeting of the German, Austrian and Swiss Societies for Thoracic and Cardiovascular Surgery in Hamburg, 17 February 2004

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1 Presented as a moderated poster at the 4th joint meeting of the German, Austrian and Swiss Societies for Thoracic and Cardiovascular Surgery in Hamburg, 17 February 2004