Beating-heart versus conventional mitral valve replacement; a randomized clinical trial (original) (raw)
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Efficacy and safety of beating heart mitral valve replacement
International cardiovascular research journal, 2014
The interest in beating heart surgery is growing since better results can be obtained with this procedure compared to conventional myocardial protection techniques using cardioplegic solutions. This led us to consider mitral valve replacement with beating heart. This study aimed to determine the safety and efficacy of beating heart mitral valve replacement without cross clamp. This prospective study was conducted on the patients with isolated mitral valve disease requiring mitral valve replacement according to ACC / AHA guidelines. In this study, 15 patients underwent mitral valve replacement using beating heart technique (Group A) and 15 ones underwent mitral valve replacement using arrested heart technique (Group B). The patients were randomized using block randomization. The data were analyzed using the SPSS statistical software. Preoperative parameters were comparable in the two groups. Most of the patients in both study groups were in NYHA class III or IV. Postoperatively, howe...
Interactive cardiovascular and thoracic surgery, 2017
The purpose of the study was to test whether a beating heart mitral valve operation was a valuable option in a heterogeneous group of patients considered very high risk for conventional mitral valve surgery. We conducted a retrospective, single-centre, observational cohort study of 120 patients (mean age 63.7 ± 12.1 years, range 25.3-88.8 years; mean logistic EuroSCORE 26.1 ± 20.6%, range 1.5-84.3%) undergoing beating heart mitral valve operations using normothermic cardiopulmonary bypass without aortic cross-clamping and without cardioplegia between September 2002 and April 2014. Preoperatively, 14 (11.7%) patients were in cardiogenic shock, 16 (13%) on a ventilator, 33 (27.5%) receiving inotropic support, 12 (10%) on dialysis and 1 on extracorporeal membrane oxygenation. Sixty-five (54%) patients had had at least 1 (range 1-6) previous heart operation. The mean follow-up period was 920 ± 973 days. A mitral valve procedure was performed alone in 75 (62.5%) patients and combined wit...
Beating Heart Mitral Valve Replacement. Experience at a Tertiary Care Hospital
Pakistan Armed Forces Medical Journal, 2021
Objective: To study the early outcomes of mitral valve surgery performed with a beating heart and cardiopulmonary bypass. Study Design: Prospective descriptive study. Place and Duration of Study: Cardiac Surgery department, Rawalpindi Institute of Cardiology, Rawalpindi, from Aug 2017 to Aug 2019. Methodology: Consecutive patients requiring mitral valve surgery were included in the study. Those requiring multiple procedures, redo procedures and emergency procedures were excluded from the study. Data was collected on preformed proformas and perioperative variables were recorded. Patients were followed till discharge or 30 days after the surgery. Statistical Package for Social Sciences version 23.0 was used to analyse the data. Results: A total of 27 patients were included in the study, 21 (77.78%) female and 6 (22.2%) male patients. The mean age of the patients was 30.89 ± 10.8 years. Of the cohort, 4 (14.8%) had mitral stenosis, 16 (59.3%) had mitral regurgitation and mixed disease ...
Beating heart versus conventional mitral valve surgery
Interactive CardioVascular and Thoracic Surgery, 2010
Objectives: The present study aimed to compare the results of beating heart technique and conventional mitral valve surgery (MVS). Methods: Three hundred and nineteen patients who underwent MVS between April 2005 and December 2006 were enrolled in the study. While 125 patients underwent beating heart MVS (group 1), the conventional approach was used for 194 patients (group 2). Of those patients who underwent beating heart MVS, 75 underwent MVS without cross-clamping the aorta. Coronary sinus retroperfusion was used during surgery in the remaining 50 patients. The right anterolateral thoracotomy was performed in nine out of the 29 patients requiring re-operation, while resternotomy was performed in 20. Results: No significant differences were shown between the groups in the preoperative period in terms of the Parsonnet mortality score, Ontario mortality score, and length of intensive care stay. However, there were significant differences with respect to EuroSCORE risk score, EuroSCORE mortality, and Parsonnet risk score, and length of hospital stay according to Ontario risk scoring. It was established that the patients in group 1 had a shorter length of hospital stay wgroup 1: six days (range, 4-37 days); group 2: 10 days (range, 4-62 days)x. Group 1 was observed to have shorter time periods when the groups were compared regarding operative time wgroup 1: 130 min (range, 100-270 min); group 2: 240 min (range, 100-360 min)x, cross-clamping (XCL) time wgroup 1: 27.5 min (range, 3-99 min); group 2: 60.5 min (range, 30-163 min)x, and cardiopulmonary bypass time wgroup 1: 57 min (range, 22-150 min); group 2: 90 min (range, 39-388 min)x. There were also significant differences in favor of group 1 in terms of postoperative need for inotropic support wgroup 1: 26 patients (16%); group 2: 68 patients (35%)x. Although there were no statistically significant differences in the groups in terms of mortality rates according to the Parsonnet scoring system, with the exception of the moderate risk group, it was noted that the mortality rates in the beating heart group were lower. Conclusions: 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.
Journal of Cardiac Surgery, 2003
Objective: The aim of this study is to evaluate in a cohort of patients with impaired left ventricular (LV) function and ischemic mitral valve regurgitation (MVR), the effects of onpump/beating heart versus conventional surgery in terms of postoperative mortality and morbidity and LV function improvement. Materials and Methods: Between January 1993 and February 2001, 91 patients with LVEF between 17% and 35% and chronic ischemic MVR (grade III-IV), underwent MV repair in concomitance with coronary artery bypass grafting (CABG) Sixty-one patients (Group I) underwent cardiac surgery with cardioplegic arrest, and 30 patients (Group II) underwent beating heart combined surgery. Aortic valve insufficiency was considered a contraindication for the on-pump/beating heart procedure. Mean age in Group I was 64.4 ± 7 years and in Group II, 65 ± 6 years (p = 0.69). Results: The in-hospital mortality in Group I was 8 (13%) patients versus 2 (7%) patients in Group II (p > 0.1). The cardiopulmonary bypass (CPB) time was significantly higher in Group I (p < 0.001). In Groups I and II, respectively (p > 0.1), 2.5 ± 1 and 2.7 ± 0.8 grafts per patient were employed. Perioperative complications were identified in 37 (60.7%) patients in Group I versus 10 (33%) patients in Group II (p = 0.025). Prolonged inotropic support of greater than 24 hours was needed in 48 (78.7%) patients (Group I) versus 15 (50%) patients (Group II) (p = 0.008). Postoperative IABP and low cardiac output incidence were significantly higher in Group I, p = 0.03 and p = 0.027, respectively. Postoperative bleeding greater than 1000 mL was identified in 24 patients (39.4%) in Group I versus 5 (16.7%) in Group II (p = 0.033). Renal dysfunction incidence was 65.6% (40 patients) in Group I versus 36.7% (11 patients) in Group II (p = 0.013). The echocardiographic examination within six postoperative months revealed a significant improvement of MV regurgitation fraction, LV function, and reduced dimensions in both groups. The postoperative RF was significantly lower in Group II patients 12 ± 6 (%) versus 16 ± 5.6 (%) in Group I (p = 0.001). The 1, 2, and 3 years actuarial survival including all deaths was 91.3%, 84.2%, and 70% in Group I and 93.3%, 87.1%, and 75% in Group II (p = ns). NYHA FC
The Journal of Thoracic and Cardiovascular Surgery, 1997
This experiment examined the feasibility of minimally invasive port-access mitral valve replacement via a 2.5 cm incision. Methods': The study evaluated valvular performance and myocardial functional recovery in six mongrel dogs after port.access mitral valve replacement with a St. Jude Medical prosthesis (St. Jude Medical, Inc., St. Paul, Minn.). Femoro-femoral cardiopulmonary bypass and a balloon catheter system for myocardial protection with cardioplegic arrest (Heartport. Inc., Redwood City, Calif.) were used. The mitral valve was replaced through a 2.5 cm port in the left side of the chest. and the animals were weaned from bypass. Cardiac function was measured before and at 30 and 60 minutes after bypass. Left ventricular pressure and electrical conductance volume were used to calculate changes in load-independent indexes of ventricular function. Results: Each procedure was successfully completed. Recovery of left ventricular function was excellent at 30 and 60 minutes after bypass compared with the prebypass values for elastance I30 minutes = 4.04 + 0.97 and 60 minutes = 4.27-0.57 vs prebypass = 4.45-0.96; p = 0.51) and for preload recruitable stroke work (30 minutes = 76.23-+ 4.80 and 60 minutes = 71.21-2.99 vs prebypass = 71.23-+ 3.75; p = 0.45). Preload recruitable work area remained at 96% and 85% of baseline at 30 and 60 minutes (p = not significant). In addition, transesophageal echocardiography demonstrated normal prosthetic valve function, as well as normal regional and global ventricular wall motion. Autopsy revealed secure annular-sewing apposition and normal leaflet motion. Conclusions: These results suggest that minimally invasive mitral valve replacement using percutaneous cardiopulmonary bypass with cardioplegic arrest is technically reproducible, achieves normal valve placement, and results in complete cardiac functional recovery. Minimally invasive mitral valve replacement is now feasible, and clinical trials are indicated.
European Journal of Cardio-Thoracic Surgery, 2008
Objective: To evaluate postoperative outcome of emergency surgery for acute severe mitral regurgitation (ASMR) from a multicentre experience. Methods: In six centres, 279 patients (mean age 62 AE 14 years, 62% female) undergoing emergency surgery for ASMR from December 1986 to March 2007 were analysed and followed up. Aetiology included acute myocardial infarction (AMI) in 126 patients (group 1, 45%), degenerative mitral valve disease in 74 (group 2, 26%), and acute endocarditis (AE) in 79 (group 3, 28%). Preoperatively, all patients were in haemodynamic instability, with 185 patients in cardiogenic shock (66%), 184 (66%) intubated, and 61 (22%) on IABP, respectively. Valve repair was performed in 76 (27%), whereas 203 (73%) underwent valve replacement. Median follow-up (98% complete) was 70.8 months (inter-quartile range 59.8-86.66 months). Results: Overall 30-day mortality was 22.5% (63/279). Early death was significantly lower in group 2 ( p < 0.001 and p = 0.005 vs group 1 and 3, respectively) whereas no difference was detected between group 1 and 3. At logistic regression analysis AMI, AE, shock, left ventricular dysfunction, and coronary artery disease were predictors of early death. Overall 15-year survival was 67 AE 10%. Survival was lower in group 1 (39 AE 11%) than in group 2 (75 AE 9%) and group 3 (77 AE 10%). Cox regression found AMI, and associated coronary artery disease to be predictors of late death. Overall 15-year actuarial and actual freedom from cardiac-related events were 44 AE 9% and 28 AE 10%, respectively, with the worst outcome in the presence of AE. Associated coronary artery disease, AE, AMI, preoperative atrial fibrillation, and chronic renal failure were independent predictors of cardiac-related events. Conclusions: Emergency surgery for ASMR remains a surgical challenge for high incidence of early and late cardiac-related events, particularly in patients with associated coronary artery disease and acute endocarditis. Apparently, type of mitral valve surgical approaches (repair or replacement) did not provide any influence on postoperative outcome. #