title: [Mid-term results after stentless mitral valve replacement. Comparison to conventional mitral valve replacement and mitral valve repair].
abstract: 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.
authors: Klinik für Herzchirurgie, Herzzentrum, Universität Leipzig, Strümpellstrasse 39, 04289, Leipzig, Germany. sven.lehmann@med.uni-leipzig.de
authors: Sven
authors: S
authors: Lehmann
authors: Thomas
authors: T
authors: Walther
authors: Jörg
authors: J
authors: Kempfert
authors: Sergey
authors: S
authors: Leontyev
authors: David
authors: D
authors: Holzhey
authors: Ardawan Julian
authors: AJ
authors: Rastan
authors: Volkmar
authors: V
authors: Falk
authors: Friedrich Wilhelm
authors: FW
authors: Mohr
mesh_terms: 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