Beating heart versus conventional mitral valve surgery

Babaroglu, Seyhan; Yay, Kerem; Parlar, Ali İhsan; Ateş, Can; Mungan, Ufuk; Çiçekçioğlu, Ferit; Tütün, Ufuk; Katırcıoğlu, Salih Fehmi

doi:10.1510/icvts.2010.255240

Cited by 7 publications

(6 citation statements)

References 13 publications

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“…The beating mitral valve replacement yields low mortality and morbidity rates, it has shorter operative times, postoperative intubations time and length of hospital stay as compared to the conventional method. Furthermore, less drainage volume and less blood transfusion were observed in this group 8 . According to a study there are great advantages of beating heart valve surgery as for example, 1 the perfused myocardial muscle, 2 the heart is not doing any work, 3 no reperfusion, 4 the possibility for ablation of atrial fibrillation on the beating heart, and 5 testing of the mitral valve repair is done in real physiologic conditions in the state of left ventricle beating tonus.…”

Section: Resultsmentioning

confidence: 64%

“…The primary aim of this study was to evaluate and compare safety of Mitral valve replacement on beating heart without using cross clamp with the convention Mitral valve replacement in terms of post operative Neuro Cognitive function, ICU stay, ventilation time, inotropes time and CPK and CK-MB levels. (Simply cardiac enzymes should be operated defunctions [1][2][3][4][5][6][7][8] .…”

Section: Introductionmentioning

confidence: 99%

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Mitral Valve Replacement on Beating Heart;

Ahmad¹,

Hussain²,

Shahzad³

2018

TPMJ

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Introduction: Cardiac reperfusion injury is a well-described complication occurringafter ischemia or following cardioplegic arrest. The primary aim of this study was to evaluateand compare safety of Mitral valve replacement on beating heart without using cross clampwith the conventional Mitral valve replacement. Material and methods: It was a retrospectiveobservational study for study duration from 2012-2014. A total of 50 patients were randomlyselected and were divided in 2 groups, 25 patients in each group. This study was conductedat the Department of Cardiovascular Surgery of Choudhry Pervaiz Elahi Institute of Cardiology,Multan. We divided the patients in two groups. All operations were carried out by team led bya consultant surgeon in our institution. Results: Our patients had the age range from 12 to 65years (Mean ages=32.5 years ± 13.9000) the mostly this study included males 60 %. The studyincluded Group A and Group B (beating heart versus conventional heart surgery) both groupscontained randomized controlled patients with purposeful sampling. Minimum operative time100 minutes or maximum operative time 160 minutes (Mean 195± 95.75) The P value remainednon significant that P <0.001. The CPB time was 22 to 388 minutes (104.8 ± 97.4. Cross Clamptime, ICU stay intubation time, drainage, inotrope remained almost same in both groups. With P<0.001 Outcome variables of the patients. Discussion: The hazards of cardiopulmonary bypassand Cardioplegia are well known. Various studies have demonstrated decreased accumulationof extra cellular fluid, diminished lactate production and greater preservation of high energystores when a strategy of myocardial protection simultaneous antegrade/ retrograde continousnormothermic, normokalemic blood perfusion was used. These findings were the basis forusing beating heart technique for mitral valve replacement, Aortic cross-clamping, Cardioplegia,and reperfusion injury leads to myocardial ischemia and is a critical issue in mitral valve surgerydespite novel approaches to myocardial protection. Myocardial edema induced by the lack ofmyocardial contractions and impaired lymphatic flow due to Cardioplegia in the heart remainingin diastole is another cause of myocardial dysfunction. Conclusions: Outcomes obtained usingthis strategy of myocardial protection seem to compare favorably to those of historical series inwhich conventional myocardial protection with cardioplegic arrest were used.

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Section: Resultsmentioning

confidence: 64%

Section: Introductionmentioning

confidence: 99%

Mitral Valve Replacement on Beating Heart;

Ahmad¹,

Hussain²,

Shahzad³

2018

TPMJ

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“…This knowledge has been extrapolated, but not proven by most these studies that beating heart protects against mitochondrial and cellular damage [6,10,23]. Even though our study had the limitation of small number of patients included into the study, the analysis of 2400 microphotographies from 102 biopsies performed among those 34 patients studied patients, do not support the idea of more injury occur in one technique than the other.…”

Section: Discussionmentioning

confidence: 76%

“…Also, the optimal flow rate are not yet determined, it has been suggested that between 150-250ml/min is the minimal necessary to warrant 4-5% of the total cardiac output [6,9]. A limitation of our study was a small number of patients in both groups to careful evaluate this variable.…”

Section: Discussionmentioning

confidence: 92%

“…Several complications are well documented in arrested heart surgery such as increasing the need for inotropic drug support, intra-aortic balloon pumping, prolonging of the length of intensive care, prolonging of hospital stays, increasing cost and mortality rates [5]. Also, low cardiac output syndrome and severe arrhythmias are associated with postoperative morbidity and mortality [6]. Although beating heart valve replacement with continuous coronary sinus perfusion is a good method for myocardial protection because eliminate the use of cardioplegia corollary risk of ischemic reperfusion injury [7,8].…”

Section: Introductionmentioning

confidence: 99%

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Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery

Cueva

M²,

Mendes³

et al. 2013

Revista Brasileira De Cirurgia Cardiovascular

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270Rev Bras Cir Cardiovasc | Braz J Cardiovasc SurgRev Bras Cir Cardiovasc 2013;28(2):270-80 Cueva CNC, et al. -Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery RBCCV 44205-1467 DOI: 10.5935/1678 Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery Objectives: This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested heart with cold blood anterograde cardioplegia.Methods: Randomized study to evaluate myocardial cellular ischemia-reperfusion of both techniques to replace the mitral valve. Thirty-four patients were randomly assigned into group A (beating heart) and group B (arrested heart). The following parameters were assessed: echocardiography, blood chemistry, hemoglobin, lactate. During the surgical procedure a total of 102 myocardial biopsies were performed for ultrastructural analysis from anterior left ventricular wall: before cardiopulmonary bypass, before aortic desclamping and 10 minutes after reperfusion.Results: Elevation of lactate at 3 hours during the procedure was higher in group A, but similar at the end of surgery (P=0.06). Cardioversion was necessary in 5/17 (A) vs. 13/17 (B) P=0.07. Median intraoperative systemic temperature was significantly lower in the group B compared to A (32ºC vs. 36ºC), P<0.001. There was no significant difference of the ultramicroscopic aspects of the heart biopsies before, during and after surgery in both groups. Cellular and mitochondrial transient abnormalities such as mitochondrial swelling, glycogen loss and cytosol swelling were detected independently of the moment of the biopsies.Conclusion: Myocardial protection and ultrastructural abnormalities were similar for both types of mitral valve replacement beating or arrested heart techniques.Descriptors: Heart Arrest, Induced. Myocardium. Mitral Valve, Surgery. 271Rev Bras Cir Cardiovasc | Braz J Cardiovasc Surg Bras Cir Cardiovasc 2013;28(2):270-80 Rev

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Leakage test during mitral valve repair

Watanabe

Arai

2014

Gen Thorac Cardiovasc Surg

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Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test. There are sometimes differences between the findings of the leakage test in an arrested heart and the echocardiographic findings after surgery. Assessment of the mitral valve in an arrested heart may not accurately reflect its function in a contractile heart. Assessment of the valve on the beating heart induced by antegrade or retrograde coronary artery perfusion can provide a more physiological assessment of the repaired valve. Perfusion techniques during beating heart surgery mainly include antegrade coronary artery perfusion without aortic cross-clamping, and retrograde coronary artery perfusion via the coronary sinus with aortic cross-clamping. It is the most important point for the former approach to avoid air embolism with such precaution as CO2 insufflation, left ventricular venting, and transesophageal echocardiography, and for the latter approach to maintain high perfusion flow rate of coronary sinus and adequate venting. Leakage test during mitral valve repair increasingly takes an important role in successful mitral valve reconstruction.

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Beating heart versus conventional mitral valve surgery

Abstract: This study concluded that beating heart MVS can be performed successfully, particularly for patients at higher risk which will lead to increased morbidity and mortality in postoperative period.

Cited by 7 publications

References 13 publications

Mitral Valve Replacement on Beating Heart;

Mitral Valve Replacement on Beating Heart;

Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery

Leakage test during mitral valve repair

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