Clinical experience with stentless mitral valve replacement.

Abstract

Our aim is to describe the clinical experience with stentless mitral valve (SMV) replacement with special focus on the functionality of the SMV. Fifty-two patients (68 +/- 8.5 years old; 36 female) have been prospectively evaluated since August 1997. The chordally supported SMV (Quattro) was implanted for mitral stenosis (n = 26), severe incompetence (n = 17), or mixed lesion (n = 9). Preoperative New York Heart Association class was 3.1 +/- 0.6. Twenty patients received additional intraoperative ablation therapy. Mean follow-up is 37.3 +/- 18.7 months (range, 1 to 65). Surgery was performed using conventional sternotomy (33) or anterolateral minithoracotomy (19). Atrial rhythm was reestablished in 17 of 20 patients. Six patients operated on early in this series required reoperation, 2 for paravalvular leakage, 2 for functional stenosis, 1 with pannus formation due to underlying rheumatoid disease, and 1 for papillary flap rupture after 5.1 years. Mortality was 1 perioperative (1.9%, nonvalve related) and 1 after reoperation due to multiorgan failure. During late follow-up (30 +/- 7 months postoperatively) 5 patients died of noncardiac causes. Regular echocardiographic control revealed good SMV function (maximum transmitral blood flow velocity 1.7 +/- 0.2 m/s; mean transmitral pressure gradient 3.9 +/- 1.2 mm Hg) and well-preserved ejection fraction postoperatively as well as at most recent follow-up. The clinical experience after 5.5 years of SMV implantation is promising. Preservation of annuloventricular continuity is advantageous. However, long-term durability remains to be proved.