[Mid-term results after stentless mitral valve replacement. Comparison to conventional mitral valve replacement and mitral valve repair].
OBJECTIVE
To evaluate the clinical results after stentless (SMV) in comparison to mitral valve repair (MV-rep) and conventional mitral valve replacement (MVR) at 5 years.


METHODS
From 08/1997 onward, 155 patients with degenerative mitral valve (MV) disease received an SMV (n=53, 68+/-8 years, 37 female), MV-rep (n=51, 69+/-9 years, 32 female), or MVR (n=51, 66+/-9 years, 32 female). The underlying MV disease was stenosis in 13 (SMV)/1 (MV-rep)/4 (MVR), incompetence in 13 (SMV)/50 (MV-rep)/30 (MVR), and combined lesion in 27 (SMV)/0 (MV-rep)/12 (MVR) patients, respectively. Preoperative New York Heart Association (NYHA) functional class was 3.1+/-0.6 (SMV)/2.9+/-0.5 (MV-rep)/2.9+/-0.6 (MVR), Euroscore 5.2+/-2.3 (SMV), 5.0+/-1.9 (Mv-rep), 4.8+/-2.6 (MVR), left ventricular ejection fraction 60.5+/-10% (SMV)/57.3+/-13% (MV-rep)/58.7+/-13% (MVR), and cardiac index 2.1+/-0.8/2+/-0.7/2+/-0.8 l/min/m2 (not significant). Follow-up includes 64+/-18 months (21-89 months).


RESULTS
Surgery was performed via conventional sternotomy (32 SMV/20 MVR-rep/34 MVR) or right anterolateral minithoracotomy (21/31/17). Cross-clamp duration was 81+/-33 (SMV)/58+/-24 (MV-rep)/54+/-23 min (MVR; p<0.05). Mean pressure gradients amounted to 4.8+/-1.9/3.6+/-1.7/4.3+/-1.4 mmHg, and valve opening areas to 2.5+/-0.6/3+/-0.9/2.6+/-0.9 cm2, respectively. In-hospital mortality was 1 (SMV)/2 (MV-rep)/5 (MVR) patients (p<0.05). During follow-up, repeat surgical interventions were required in 6 (SMV)/2 (MV-rep)/3 (MVR) patients. 5-year survival was 80.5+/-4.4% (SMV)/82.6+/-5.6% (MV-rep)/80.2+/-5.5% (MVR; not significant); this was comparable to an age-matched normal population.


CONCLUSIONS
At 5 years, the SMV compares favorably with conventional standards when taking the patients' risk profile into account. The SMV with its reliable functional and hemodynamic outcome may be the mitral prosthesis of choice in future.
Lehmann
Sven
S
Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany. sven.lehmann@med.uni-leipzig.de
Walther
Thomas
T
Kempfert
Jörg
J
Leontyev
Sergey
S
Holzhey
David
D
Rastan
Ardawan Julian
AJ
Falk
Volkmar
V
Mohr
Friedrich Wilhelm
FW
D000368:Aged; D013504:Cardiovascular Surgical Procedures / Q000379:methods*; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D015607:Stents; D016896:Treatment Outcome