Surgical treatment of valvular heart disease: Part V. Prosthetic replacement of the mitral valve

Abstract

Extensive experience has been gained with prosthetic replacement of the mitral valve since it was first introduced by Starr in 1961. Operative mortality following prosthetic replacement has decreased to about 10 per cent, but 10 to 15 per cent of patients subsequently die in the first two years following operation, either from complications related to the prosthesis or from their underlying cardiac disease. Hence, at present, operation should be recommended only for patients with progressive disability from valvular disease. Following mitral replacement, about 65 per cent of patients become asymptomatic, 25 per cent have mild symptoms, and for unknown reasons about 10 per cent remain with significant disability. A potentially very significant advance has been made in the past year with the introduction of cloth-covered prostheses, which from presently available data indicate that the incidence of thromboembolism may be decreased from the range of 20 to 25 per cent to as low as 2 to 4 per cent. This advance, if confirmed, may greatly liberalize future indications for mitral valve replacement. Only preliminary experiences are yet available with homograft and heterograft prostheses.