MITRAL VALVE REPLACEMENT ON BEATING HEART;

SAFETY--------AN EVALUATION

Abstract

Introduction: Cardiac reperfusion injury is a well-described complication occurring
after ischemia or following cardioplegic arrest. 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 conventional Mitral valve replacement. Material and methods: It was a retrospective
observational study for study duration from 2012-2014. A total of 50 patients were randomly
selected and were divided in 2 groups, 25 patients in each group. This study was conducted
at 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 by
a consultant surgeon in our institution. Results: Our patients had the age range from 12 to 65
years (Mean ages=32.5 years ± 13.9000) the mostly this study included males 60 %. The study
included Group A and Group B (beating heart versus conventional heart surgery) both groups
contained randomized controlled patients with purposeful sampling. Minimum operative time
100 minutes or maximum operative time 160 minutes (Mean 195± 95.75) The P value remained
non significant that P <0.001. The CPB time was 22 to 388 minutes (104.8 ± 97.4. Cross Clamp
time, 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 bypass
and Cardioplegia are well known. Various studies have demonstrated decreased accumulation
of extra cellular fluid, diminished lactate production and greater preservation of high energy
stores when a strategy of myocardial protection simultaneous antegrade/ retrograde continous
normothermic, normokalemic blood perfusion was used. These findings were the basis for
using 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 surgery
despite novel approaches to myocardial protection. Myocardial edema induced by the lack of
myocardial contractions and impaired lymphatic flow due to Cardioplegia in the heart remaining
in diastole is another cause of myocardial dysfunction. Conclusions: Outcomes obtained using
this strategy of myocardial protection seem to compare favorably to those of historical series in
which conventional myocardial protection with cardioplegic arrest were used.