Midterm results after stentless mitral valve replacement

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(TM), 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/m(2). 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 (V-max 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.