Beating Heart Surgery for Patients with Poor LV Function

Abstract

Beating heart surgery expand the surgical indications to the old patient and serious case. We present a favorable outcome of beating heart surgery for the valvular disease and the aortic aneurysm patient with low cardiac function. In every cases, we use antegrade worm blood perfusion to coronary artery. First case of a 56-year-old man with a preoperative diagnosis of severe aortic stenoinsufficiency, Fractional shortening (FS=10%) is reduced, the left ventricle is dilated (LVDd=66mm), and severe tricuspid regurgitation was detected by echocardiogram. Aortic valve replacement and tricuspid annuloplasty was performed on baeating heart. At postoperative day 1, maximal CK-MB activity was 32(10.9%)IU/I. At postoperative day 7, Fractional shortening (FS=18%) was recovered. Second case of a 77-year-old man with thoracic aorta aneurysm, At preoperative echocardiogram, poor LV function (FS=27%, E/A=0.54, LV tei index=0.81) was pointed out. Total arch replacement with elephant trunk procedure was performed on beating heart. At postoperative day 1, maximal CK-MB activity was 23(7.0%)IU/I. Postoperative LV function was almost the same (FS=21%, E/A=0.88, LV tei index=0.86). Third case of a 71-year-old man with non-ischemic dilated cardiomyopathy, severe heart failure (FS=7%) and left ventricular dilatation (LVDd=90mm), and severe mitral regurgitation was detected by echocardiogram. Left ventricular reduction surgery (Batista procedure) and mitral valve plasty was performed on beating heart. We got an early postoperative recovery of LV function in every cases.