Stentless mitral valve replacement in comparison with conventional mitral valve repair or replacement at five years

Objective To evaluate the clinical results after stentless (SMV) in comparison to conventional mitral valve replacement (MVR) or mitral valve repair (MV-rep) at five years. Methods From 08/97 onwards 155 patients with degenerative mitral valve (MV) disease received a SMV (n=53, 68 +/- 8 yrs, 37 female), MVR (n=51, 69 +/- 9 yrs, 32 female) or MV-rep (n=51, 66 +/- 9 yrs, 32 female). The underlying MV disease was stenosis in 14/4/0, incompetence in 12/30/51 and combined lesion in 27/17/0 patients, respectively. NYHA functional class was 3.1 +/- 0.6/2.9 +/- 0.5/2.9 +/- 0.6; Euroscore 4.7 +/- 2.1/4.4 +/- 1.9/4.2 +/- 2.6; left ventricular ejection fraction 64 +/- 12%/63 +/- 16%/61 +/- 14% and cardiac index 2.1 +/- 0.8/2 +/- 0.7/2 +/- 0.8 1/min/m(2). Follow-up indudes 54 +/- 18 (11-79) months. Results Surgery was performed via conventional sternotomy (32/20/34) or right anterolateral minithoracotomy (21/31/17). Crossdamp duration was 81 +/- 33/58 +/- 2 4 / 5 4 +/- 23 min (p < 0.05). In hospital mortality was 1/5/2 patients. Mean pressure gradients were 4.8 +/- 1.9/4.3 +/- 1.4/2.9 +/- 1.2 mmHg and valve opening areas 2.9 +/- 0.7/3.2 +/- 0.8/3.3 +/- 0.8 cm(2), respectively. During follow-up repeat surgical interventions were required in 6/3/2 patients. Five year survival was 80 +/- 4%/80 +/- 5%/82 +/- 5% (p = n.s); this was comparable to an age-matched normal population. Conclusion At five years the stentless mitral valve compares favorably to 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.