A New Technique of Myocardial Protection during Aortic Root Replacement: Antegrade/Retrograde Coronary Perfusion

Abstract

Aortic root surgery has traditionally been performed with an arrested and cooled heart using cardioplegia. A new technique of myocardial protection was utilized in the treatment of ascending aortic aneurysm with severe aortic valve regurgitation requiring aortic root replacement with the Cabrol technique. Retrograde and antegrade perfusion of the heart with blood allowed the surgical operation to be performed safely while the heart was beating and eliminated the ischemic reperfusion injury which occurs during cardioplegic arrest and reinstitution of blood perfusion after removal of the aortic cross-clamping required in traditional techniques.

On-Pump Beating Heart Mitral Valve Surgery without Cross-Clamping the Aorta

“…On the other hand, allowing the heart beat during the operation might reduce the risk of myocardial edema and provide better cardiac function. Beating heart valve surgery for the mitral valve has gained popularity in some centers recently 5–13 . This technique is simple and it shortens the duration of CPB and total operation.…”

“…Beating heart valve surgery for the mitral valve has gained popularity in some centers recently. [5][6][7][8][9][10][11][12][13] This technique is simple and it shortens the duration of CPB and total operation. Besides, it eliminates the risk of myocardial ischemia during cardioplegic arrest and reperfusion injury afterward.…”

“…Our targets were maintenance of normothermic blood supply to the myocardium, while eliminating undetected ischemia and reperfusion injury and avoidance of the side effects of hypothermia and aortic cross-clamping. 8,[12][13][14][15][16][17] The aim of this study was to assess the efficacy and applicability of on-pump beating heart mitral valve surgery without using aortic cross-clamp and cardioplegic arrest. by the same surgeon at our institution.…”

“…We adopted a technique for mitral valve surgery with normothermic cardiopulmonary bypass (CPB) without cross‐clamping the proximal aorta while maintaining myocardial perfusion antegradely through the aortic root for myocardial protection. Our targets were maintenance of normothermic blood supply to the myocardium, while eliminating undetected ischemia and reperfusion injury and avoidance of the side effects of hypothermia and aortic cross‐clamping 8,12–17 …”

Beating heart mitral valve replacement in a patient with a previous Bentall operation

“…1,4 We also have an onpump beating heart valve replacement series with acceptable clinical results. 2,[6][7][8][9] The patient had had root replacement due to type I aortic dissection 4 years previously. The tube graft was between the aortic root and below the aortic arch.…”