Early results with stentless mitral valve replacement.
OBJECTIVE
Implantation of a chordally supported stentless mitral valve (SMV) may be the strategy of choice for patients with severe degenerative mitral valve disease. Herein, the early clinical results of this surgical technique were analyzed.


METHODS
Since August 1997, 52 patients (36 females, 16 males; mean age 68.0 +/- 8.5 years) each received a SMV (Quattro; St. Jude Medical Inc.) at the authors' institution. The underlying disease was predominant mitral stenosis (n = 26), incompetence (n = 17) and combined lesion (n = 9). The mean NYHA class was 3.1 +/- 0.6, left ventricular ejection fraction 64 +/-13%, and cardiac index 2.1 +/- 0.8 1/min/m2.


RESULTS
SMV implantation was performed using either a conventional sternotomy (n = 33) or a lateral minithoracotomy (n = 19). The mean implanted valve size was 29.2 +/- 1.7 mm, and mean cross-clamp time 81 +/- 33 min. Reoperation was required in six patients: two for paravalvular leakage, two for functional stenosis (both 26 mm valves), in one patient for pannus formation with underlying collagenosis, and in one for papillary flap rupture at five years. One patient died perioperatively, one died after reoperation at one year, and five patients died at longer follow up, from non-cardiac causes. Hemodynamic function was shown to be normal on echocardiography.


CONCLUSIONS
Intermediate-term results after SMV implantation were promising. Preservation of annuloventricular continuity led to good left ventricular function, but long-term durability remains to be proven.
Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Leipzig, Germany. walt@medizin.uni-leipzig.de
Thomas
T
Walther
Sven
S
Lehmann
Volkmar
V
Falk
Claudia
C
Walther
Nico
N
Doll
Bianca
B
Uhlig
Marika
M
Viehweg
Sebastian
S
Metz
Friedrich W
FW
Mohr
D000368:Aged; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome