Restitution of sinus rhythm plus stentless mitral valve replacement at three years.
OBJECTIVE
The study aim was to examine results after stentless mitral valve (SMV) replacement (Quattro) and restitution of physiological cardiac rhythm by intraoperative left atrial ablation therapy.


METHODS
Twenty patients (13 females; mean age 69.7 +/- 5.9 years) with severe degenerative mitral valve disease (six with valve stenosis, six with valve incompetence, eight with combined lesion) were prospectively evaluated since 1998. The mean NYHA functional class was 3.2 +/- 0.4, and cardiac index 1.8 +/- 0.5 l/min/m2. Ablation therapy was performed by inducing left atrial linear lesion lines to avoid reentrant circuits.


RESULTS
Surgery was performed using conventional sternotomy (n = 10) or lateral minithoractomy (n = 10). Sinus rhythm was successfully restituted in 17 patients either postoperatively or in the long term (success rate 85%). However, three patients required DDD-pacemaker implantation, and another three had to be discharged with persistent atrial fibrillation. Intermittent medical therapy (sotalol or amiodarone) was required in nine patients postoperatively, in four patients at six months, and in two patients at one-year follow up. One patient was reoperated on for paravalvular leak after one year, but subsequently died due to sepsis. In the other patients, echocardiographic control proved good SMV function with atrial contraction.


CONCLUSIONS
Restitution of physiological cardiac function is possible by combined stentless MV implantation and left atrial ablation therapy. A persistent benefit, without need for additional re-intervention, was shown at mid-term follow up.
Lehmann
Sven
S
Department of Cardiac Surgery, Heartcenter, University of Leipzig, Strümpellstr. 39, 04289 Leipzig, Germany.
Walther
Thomas
T
Falk
Volkmar
V
Metz
Sebastian
S
Doll
Nico
N
Hindricks
Gerd
G
Mohr
Friedrich W
FW
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000628:therapy*; D017115:Catheter Ablation; D003452:Cryosurgery; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008946:Mitral Valve Stenosis / Q000150:complications / Q000601:surgery*; D011446:Prospective Studies; D011474:Prosthesis Design; D016896:Treatment Outcome