This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Walther, T. Articles by Mohr, F. W. Search for Related Content PubMed PubMed Citation Articles by Walther, T. Articles by Mohr, F. W. Related Collections Valvular heart disease Echocardiography CV surgery: valvular disease

(Circulation. 1999;100:II-78.)
© 1999 American Heart Association, Inc.

Surgery for Valvular Heart Disease

Early Clinical Results After Stentless Mitral Valve Implantation and Comparison With Conventional Valve Repair or Replacement

Thomas Walther, MD; Claudia Walther, MD; Volkmar Falk, MD; Anno Diegeler, MD; Ralf Krakor, MD; Johannes Schneider, MD; Rüdiger Autschbach, MD; Friedrich W. Mohr, MD, PhD

From University Leipzig, Heartcenter, Departments of Cardiac Surgery and Cardiology (C.W.), Leipzig, Germany.

Correspondence to Dr Thomas Walther, Universität Leipzig, Herzzentrum, Klinik für Herzchirurgie, Russenstrasse 19, 04289 Leipzig, Germany. E-mail walt{at}medizin.uni-leipzig.de

Background—A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards.

Methods and Results—Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69±8, 64±10, and 62±9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59±19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm². Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups.

Conclusions—One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement.

Key Words: mitral valve • surgery • echocardiography • prosthesis