Efficacy, Feasibility, and Pitfalls of Transseptal Approach in Beating-Heart Mitral Valve Surgery

Abstract

Our experience suggests that beating-heart mitral valve surgery is facilitated by using the trans-septal approach.

Beating Heart Versus Arrested Heart Isolated Tricuspid Valve Surgery

“…The most important advantage of beating heart surgery is that there is no need for cardioplegic arrest of the heart, which might cause myocardial hypoxemia, malnutrition, and electrolyte imbalance. [16][17][18][19][20][21][22] This advantage is especially important in patients with preoperative myocardial hypertrophy and in those with poor ventricular function who require prolonged periods of aortic cross-clamping. 19) In the present study, patients who underwent concomitant procedures with left-sided valve surgery were excluded.…”

“…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.…”

On-pump Beating Heart Surgery

“…Some authors consider that the on-pump beating heart technique is inappropriate for surgical field exposure in patients with reduced blood return to the heart [14], or a large ventricular septal defect [14], or in mitral valve surgery in patients with a small left atrium [14], mild aortic insufficiency [14] or extensive mitral valve vegetation [70]. However, in the setting of mild aortic insufficiency, Salerno et al [85] believed that pressure on the root of the aorta from the outside usually eliminated aortic insufficiency, and another choice is a procedure using retrograde perfusion.…”

Comparison of aortic cross-clamping versus beating heart surgery in tricuspid valve repair

“…The most important advantage of cardiac surgery on a BH is that there is no need for cardioplegic arrest which may cause myocardial hypoxemia, malnutrition, and electronic imbalance. [9,[11][12][13][14][15][16] This advantage is particularly important for patients with preoperative myocardial hypertrophy and poor ventricular functions who need longer ACC times. [13] Tricuspid valve repair can be performed prior to ACC or after cross-clamp removal in patients undergoing surgery on a BH.…”