September 9, 2003Open Access
View Full PaperMidterm Results After Stentless Mitral Valve Replacement
Key Result
Stentless mitral valve replacement in patients with severe mitral valve disease demonstrated a 1.96% perioperative mortality and well-preserved left ventricular function over a mean 35.4 months.
Study Design
Type
Observational (n=51)
Structured PICO
What are the midterm clinical and echocardiographic outcomes after stentless mitral valve replacement in patients with severe mitral valve disease?
P
Population
51 patients (mean age 68.3 years) with severe mitral valve disease who underwent stentless mitral valve replacement, followed for a mean of 35.4 months.
E
Exposure
Chordally supported stentless mitral valve (SMV) replacement (Quattro, St. Jude Medical Inc.) using conventional or minimally invasive approach. Additional intraoperative ablation therapy was performed on 19 patients with chronic atrial fibrillation.
O
Outcome
Midterm clinical results including mortality, reoperation, and echocardiographic function
Stentless mitral valve replacement shows promising midterm clinical and hemodynamic results, though early reoperation was required in a subset of patients.
Limitations
- Long-term durability remains to be proven.
Abstract
BACKGROUND: To analyze the midterm clinical results after stentless mitral valve (SMV) replacement. METHODS AND RESULTS: Fifty one patients (68.3+/-8.4 years, 35 female) with severe mitral valve disease (stenosis 25, incompetence 17, mixed lesion 9) received a chordally supported SMV (Quattro, St. Jude Medical Inc.) since August 1997. Preoperative New York Heart Association class was 3.1+/-0.6; left ventricular ejection fraction 64+/-13%, and cardiac index 2.1+/-0.8 l/min/m2. Additional intraoperative ablation therapy was performed on 19 patients with chronic atrial fibrillation. Mean follow-up is 35.4+/-19.2 months (range 5 to 63). SMV implantation was performed using a conventional (32) or a minimally invasive (19) approach, valve size was 29+/-1.5 mm, cross-clamp duration was 81+/-33 minutes. Atrial rhythm was reestablished in 16 of 19 patients. Five patients required reoperation early in this series, two for paravalvular leakage, two for functional stenosis, and one with underlying rheumatoid disease. Mortality was one perioperative (1.96%, non-valve-related), one after reoperation as a result of multiple organ failure (MOF), and five during late follow-up (30+/-7 months postoperatively) for noncardiac causes. Regular echocardiographic control revealed good SMV function (Vmax 1.7+/-0.2m/s, P(mean) 3.9+/-1.2 mm Hg) and well-preserved ejection fraction postoperatively and at most recent follow-up. CONCLUSIONS: Midterm results after SMV implantation are promising. Preservation of the annuloventricular continuity leads to stable left ventricular function and combined with ablation therapy to physiological hemodynamics. Long-term durability remains to be proven.