European Journal of Cardio-Thoracic Surgery, Vol 12, 56-62, Copyright © 1997 by European Association for Cardio-thoracic Surgery
Porcine mitral stentless valve mid-term clinical results
M Vrandecic, B Gontijo, FA Fantini, I Martins, MH Oliveira, SS Avelar, O Oliveira and E Vrandecic
Department of Cardio-Thoracic Surgery, Biocor Institute, Belo Horizonte, MG, Brazil.
OBJECTIVES: Time testing is essential with any valvular procedure,
especially when a new concept is introduced such as the mitral stentless
valve. Our purpose is to evaluate the results obtained over 4 years with
this operation, particularly to attest the impact of preservation of annulo
ventricular continuity on the long term results of these patients. METHODS:
From March 1992 to August 1996, 120 patients had their mitral valves
replaced with a porcine stentless mitral valve. The observation period was
54 months with total patients follow-up of 3424 months with a mean of 28.5
months. The age ranged from 11 to 72 years (mean 35.22 +/- 14.98). There
were 73 females (60.8%) and 47 males (39.2%). The predominant etiology was
rheumatic heart disease. Associated procedures were performed in 12
patients (10%), and the great majority of the patients were in functional
class III and IV (NYHA). RESULTS: Hospital mortality occurred in seven
patients (5.83%) non valve related except for one early case of
endocarditis. Early reoperation related to technical failure were necessary
in 4 patients without mortality. Follow-up was accomplished in 101 patients
and ranged from 2 to 54 months. Late reoperations were required in 16
patients (nine due to mitral insufficiency, five because of endocarditis
and two for mitral stenosis). Most reoperations were related to technical
failure. Among the 82 patients presently in control, 72 showed a competent
mitral stentless valve, eight with stable mild mitral regurgitation and in
two a decreased mitral orifice. Hemodynamic performance of the valve has
been excellent in this group, particularly in patients with left
ventricular dysfunction. CONCLUSION: Although technical complexity remains
the main cause of reoperations with this valve, experience has shown that
it not only provides preservation of the left ventricular function but also
promised significant increase of the ejection fraction in patients with
poor left ventricular function.
