Efficacy and Safety of On-Pump Beating Heart Surgery

Mo, Ansheng; Lin, Hui; Wen, Zhaoke; Lu, Wei-jun; Long, Xiao; Zhou, Yuehua

doi:10.1016/j.athoracsur.2008.07.003

Cited by 24 publications

(29 citation statements)

References 21 publications

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“…6,15) In addition to this progress in surgical techniques, beating heart (BH) surgery for valvular disease has become attractive for many surgeons, since they expect better protection of the heart from ischemia and reperfusion injury. [16][17][18][19][20][21][22][23][24][25] However, this technique is technically more demanding and may entail drawbacks, such as potential air embolism. [19][20][21] The potential benefits of BH surgery for valve surgery are still controversial.…”

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confidence: 99%

Beating Heart Versus Arrested Heart Isolated Tricuspid Valve Surgery

et al. 2015

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We analyzed the long-term results of two surgical techniques (beating versus non-beating) for isolated tricuspid valve (TV) surgery.The long-term results of 92 consecutive patients who underwent isolated TV surgery were analyzed. We compared patients with beating heart (BH) surgery (n = 48) with patients undergoing arrested heart (AH) surgery (n = 44).BH surgery was more frequently chosen in urgent/emergent operations (P = 0.029) and in redo-operations (P < 0.001). Preoperatively, the rates of renal insufficiency (P = 0.002) and EuroSCORE (P = 0.019) were higher in the BH group than in the AH group. There were no differences in perioperative outcomes and 30-day mortality between the groups. However, freedom from reoperation was significantly lower in the BH group compared to the AH group (P = 0.039). We observed a trend towards lower survival rates at 1, 5, and 10 years in the BH group (77%, 54%, and 41%) compared to those of the AH group (86%, 75%, and 72%, P = 0.062). Multivariate Cox hazard model analysis revealed preoperative heart rhythm (P = 0.014, odds ratio [OR] = 2.296) and EuroSCORE (P = 0.022, OR = 1.049) as independent risk factors for mortality after isolated TV surgery.The superiority of BH surgery over AG surgery was not proven. Surgical intervention should be considered early, since patients with elevated EuroSCORES and arrhythmia have significantly higher mortality rates.

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confidence: 99%

Beating Heart Versus Arrested Heart Isolated Tricuspid Valve Surgery

et al. 2015

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“…Therefore, better myocardial protection strategies are very important in patients with congestive heart failure or coexistent lesions. On-pump beating-heart surgery is characterized by avoidance of ischemia-reperfusion injury and cardioplegia [13-19]. It may benefit to patients with ruptured aneurysms of the sinus of Valsalva.…”

Section: Discussionmentioning

confidence: 99%

“…The technique of CPB and heart perfusion is reported in our previous study [13]. In brief, cardiopulmonary bypass was instituted via double atrial and aortic cannulation.…”

Section: Methodsmentioning

confidence: 99%

“…Aortic valve replacement and ventricular septal defect repair using this technique have been explained in our previous study [13]. Aortic valvuloplasty, right ventricular outflow construction, and radical resection of subaortic stenosis were performed as in arrested hears.…”

Section: Methodsmentioning

confidence: 99%

“…Therefore, myocardial protection is key to the success of these operations. Evidence from experimental and clinical work has demonstrated that on-pump beating-heart surgery reduces further cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia [13-18]. …”

Section: Introductionmentioning

confidence: 99%

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Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique

Lin

2010

J Cardiothorac Surg

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BackgroundRupture of aneurysms of the sinus of Valsalva results in abrupt onset of congestive heart failure. On-pump beating-heart surgery may reduce cardiac impairment by maintaining coronary blood flow and avoiding cardioplegia. Herein, we report the operative correction of thirty-one patients of ruptured aneurysms of the sinus of Valsalva, using the on-pump beating-heart technique.MethodsThirty-one patients with ruptured aneurysms of the sinus of Valsalva underwent operative corrections using the on-pump beating-heart technique. In patients with fistula diameter less than 1 cm and no aortic regurgitation, the aorta was unclamped throughout cardiopulmonary bypass(CPB) while receiving antegrade heart perfusion. In remainder of patients, retrograde perfusion was used.ResultsAfter intracardiac manipulation was complete and the nasopharyngeal temperature was raised to 36-37°C, the patients were smoothly weaned off CPB. There were no early or late postoperative deaths. All patients were in New York Heart Association functional class I at follow-up (range, 0.5-1 year). Mild-to-moderate aortic valve regurgitation was observed in one patient. No recurrence of the left-to-right shunt from ruptured aneurysms of the sinus of Valsalva was observed.ConclusionsBeating heart on pump allows adequate examination of the aortic lesion under near-physiologic conditions, allows decrease in ischemia-reperfusion injury and potentially decreases the risk of serious or fatal rhythm disturbances. On-pump beating-heart technique for repair of ruptured aneurysm of sinus of Valsalva is feasible and promising. Antegrade heart perfusion is suitable for patients with a fistula diameter <1 cm and no aortic regurgitation, and retrograde perfusion is suitable for the others.

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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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Efficacy and Safety of On-Pump Beating Heart Surgery

Cited by 24 publications

References 21 publications

Beating Heart Versus Arrested Heart Isolated Tricuspid Valve Surgery

Beating Heart Versus Arrested Heart Isolated Tricuspid Valve Surgery

Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique

Leakage test during mitral valve repair

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