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DOI: 10.1055/s-2004-816692
Stentless mitral valve replacement at five years: Comparison to conventional mitral valve repair or replacement
Objective: To analyze the five year functional and hemodynamic outcome after stentless mitral valve (SMV) replacement in comparison to conventional mitral valve repair or replacement.
Methods: 155 patients receiving mitral valve surgery since 08/97 were studied in three groups: 53 patients (68±8 years, 37 female, valve repair not feasible) received a SMV (QuattroTM), 51 patients (69±9 years, 32 female) received mitral valve repair (MVR) and 51 patients (66±9 years, 32 female) received conventional mitral valve replacement (MVP). There were no significant differences regarding preoperative NYHA-functional class, left ventricular ejection fraction, cardiac index and surgical risk according to the Euroscore. Mean follow-up is 54±18 (11–79) 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 attached to the papillary muscles thus preserving annulo-ventricular continuity. In-hospital mortality was 1, 2 and 4 patients (p<0.05). Reoperation had to be performed in 6, 2 and 3 patients, all SMV patients requiring reoperation were operated early in this series. Five year survival was 78% (SMV), 80% (CMV) and 82% (MVP), p=n.s. Causes of death during follow-up were mostly non-cardiac, 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. Long term follow up will be required.