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

Abstract

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 69Ϯ8, 64Ϯ10, and 62Ϯ9 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 59Ϯ19 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 cm 2. 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. (Circulation. 1999;100[suppl II]:II-78-II-83.) Key Words: mitral valve Ⅲ surgery Ⅲ echocardiography Ⅲ prosthesis M itral valve surgery is characterized by improved methods of valve repair in selected patients. Mitral valve replacement (MVP) is indicated mainly for advanced disease with severe destruction or calcification. Although a routine operation, valve selection is still controversial, since no ideal artificial heart valve is available at the moment. 1,2 Bioprostheses are usually indicated in patients older than 70 years. 3 Nevertheless, complications such as structural valve failure, calcification, thrombosis, and anticoagulation-related hemorrhage are associated with artificial heart valves. 4-6 In the mitral position, freedom from these complications is Ϸ70% at 10 years and 35% at 15 years for porcine bioprostheses and Ϸ77% at 10 years for pericardial bioprostheses. 7-9 Currently, no standard for valve selection exists; the best option would be a durable, flexible biological prosthesis resembling the native mitral valve. Anatomically, the mitral valve is a complex structure, like the individual fingerprint. Perfect function is guaranteed through the interaction of valve leaflets, chordae, ...

Minimally-Invasive Valve Surgery

“…Recently, another group reported the results of 25 patients receiving successful telemanipulator-supported mini-MVS (38); however, long-term results are not available. Other centers (Leipzig) had similar positive experiences using the telemanipulator-supported techniques in the late 1990s (39,40). However, they later abandoned this technique, given the lack of difference compared with their "standard" approaches.…”

Minimally Invasive Mitral Valve Procedures: The Current State

“…Telemanipulator-supported operations, which involve femoral cannulation and direct or endoluminal aortic clamping, have been used and propagated by Chitwood et al [9, 18] and others [29, 30], who claim that this technique could be safely and effectively used [7]. Other centers (Leipzig) had similar positive experiences using the telemanipulator-supported techniques in the late 1990s [31, 32]. However, they later abandoned this technique, given the lack of difference compared with their “standard” approaches.…”

Cardiac surgery A simple heart valve replacement technique which improves surgical time

“…In this study standard MVR cross clamp time was found as 64.6 min [9]. Another study demonstrated a cross clamp time of 43 ±15 min for conventional MVR technique [10]. In the presented technique, the cross clamp time was 30.7 ±3.3 min for MVR.…”