Mid-term results after stentless mitral valve replacement. Comparison to conventional mitral valve replacement and mitral valve repair

摘要

PURPOSE: To evaluate the clinical results after stentless (SMV) in comparison to mitral valve repair (MV-rep) and conventional mitral valve replacement (MVR) at 5 years. PATIENTS AND METHODS: From 08/1997 onward, 155 patients with degenerative mitral valve (MV) disease received an SMV (n=53, 68+/-8 years, 37 female), MV-rep (n=51, 69+/-9 years, 32 female), or MVR (n=51, 66+/-9 years, 32 female). The underlying MV disease was stenosis in 13 (SMV)/1 (MV-rep)/4 (MVR), incompetence in 13 (SMV)/50 (MV-rep)/30 (MVR), and combined lesion in 27 (SMV)/0 (MV-rep)/12 (MVR) patients, respectively. Preoperative New York Heart Association (NYHA) functional class was 3.1+/-0.6 (SMV)/2.9+/-0.5 (MV-rep)/2.9+/-0.6 (MVR), Euroscore 5.2+/-2.3 (SMV), 5.0+/-1.9 (Mv-rep), 4.8+/-2.6 (MVR), left ventricular ejection fraction 60.5+/-10% (SMV)/57.3+/-13% (MV-rep)/58.7+/-13% (MVR), and cardiac index 2.1+/-0.8/2+/-0.7/2+/-0.8 l/min/m2 (not significant). Follow-up includes 64+/-18 months (21-89 months). RESULTS: Surgery was performed via conventional sternotomy (32 SMV/20 MVR-rep/34 MVR) or right anterolateral minithoracotomy (21/31/17). Cross-clamp duration was 81+/-33 (SMV)/58+/-24 (MV-rep)/54+/-23 min (MVR; p<0.05). Mean pressure gradients amounted to 4.8+/-1.9/3.6+/-1.7/4.3+/-1.4 mmHg, and valve opening areas to 2.5+/-0.6/3+/-0.9/2.6+/-0.9 cm2, respectively. In-hospital mortality was 1 (SMV)/2 (MV-rep)/5 (MVR) patients (p<0.05). During follow-up, repeat surgical interventions were required in 6 (SMV)/2 (MV-rep)/3 (MVR) patients. 5-year survival was 80.5+/-4.4% (SMV)/82.6+/-5.6% (MV-rep)/80.2+/-5.5% (MVR; not significant); this was comparable to an age-matched normal population. CONCLUSION: At 5 years, the SMV compares favorably with 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.