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On-pump Beating Heart Versus Arrested Heart Mitral Valve Replacement - Efficacy and Safety

Vivek Tewarson, Assistant Professor, Department of CVTS, King George's Medical University, Lucknow, Uttar Pradesh 226003, India , Devenraj Vijayant , Tewarson Vivek , Kumar Sarvesh , Misra Shradha , Kushwaha B. Brij ,

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Journal of Cardiovascular Medicine and Surgery 4(4):p 281-286, Oct-Dec 2018. | DOI: http://dx.doi.org/10.21088/jcms.2454.7123.4418.4

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Abstract

Introduction: This study is aimed to determine the ef cacy and  safety of beating heart mitral valve replacement (MVR) surgery without aortic cross clamping (ACC) and continuous coronary perfusion under normothermia. Methods: This prospective study was conducted on the patients undergoing isolated MVR. In this study, 16 patients (Group A) underwent MVR using beating heart technique without ACC with continuous coronary perfusion and 16 patients underwent conventional MVR using ACC and cardioplegic arrested heart technique (Group B). The following variables were assessed: CPB time; total operative time; cardiac enzymes (CK-MB); intubation time; mediastinal drainage; blood transfusions; ionotropes use; re-explorations; cerebrovascular accidents (CVA); pulmonary complications; ICU stay days and peri-operative mortality. Results: Pre-operative data was equally matched in both the groups using propensity scoring. On analyzing intra-operative and post-operative it was found that CPB time (p<0.001), total operation time (p<0.001) ionotropic support (p<0.001), ICU stay (p=0.04) and CK-MB (p<0.001) were found to be better in Group A with statistical signi cant difference (p<0.05). The other post-operative parameters were found to be statistically non-signi cant. There was one mortality in both the group. Conclusion: Beating-heart MVR surgery is equally safe as conventional arrested MVR and provides for better myocardial protection and should be alternative method of MVR especially in poor myocardial reserve patients.

 

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DOI: http://dx.doi.org/10.21088/jcms.2454.7123.4418.4

Keywords

Beating Heart; Mitral Valve Replacement; Myocardial Protection; Arrested Heart.

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