Abstract
This study has been conducted in an effort to establish metabolic and inflammatory responses of the myocardium during aortic valve surgery on the beating heart with CPB and continuous coronary sinus perfusion with normothermic blood. Twenty patients, divided into two groups, participated in this study. Conventional aortic valvular operations were performed on first 10 patients, while the second group, consisting of 10 patients as well, was subjected to the operations with CPB on the beating heart with continuously perfusion with blood through coronary sinus. There were total of 14 biological and 6 mechanical valves implanted in aortic position. In this study, cardiac markers and inflammatory mediators IL-8 and TNF, were measured preoperatively and postoperatively. Metabolic changes were documented based on the levels of CK-MB, troponin I, myoglobin and LDH. Inflammatory factors we measured through IL-8 and TNF. All measurements were taken in 6 hour intervals during the initial 48 hours following the operations. The patients of "the beating heart" group had significantly lower dose of markers and cytokines in comparison to those who had undergone the conventional valvular operation. The elimination of the adverse effects of global ischemia produced from reperfusion injury and the similarity to the physiological condition, suggests that the revival of the beating heart procedure is more reasonable. This procedure of valvular surgery on the beating heart can be one of the good surgical options for the high-risk valvular patients.
Highlights
Does myocardial perfusion with warm blood or some another cardioplegic solution carry the same risk as similar perfusion with just warm blood without arresting cardiac function? There is some evidence that continuous warm blood perfusion offers good myocardial protection
Among patients in beating heart group CK-MB concentration were within normal limit ( ±, ) and were significantly lower than those of conventional valvular operations (, ±, ) P-value
Cardiac dysfunction may be caused by myocardial oedema intrinsic to the diastolic state of the arrested heart and every cardioplegic arrest technique will inevitably produce some degree of reperfusion injury (, )
Summary
Does myocardial perfusion with warm blood or some another cardioplegic solution carry the same risk as similar perfusion with just warm blood without arresting cardiac function? There is some evidence that continuous warm blood perfusion offers good myocardial protection. After aortic declamping some general reperfusion occurs resulting in adequate inflammatory response at the same time This inflammatory response depresses cardiac function and the activation of neutrophiles, which represents the main problem, reperfusion injury, for it allows cytokines to exert direct negative inotropic effects on the heart ( , ). This method can be one of the approaches for aortic valve patients because it prevents reperfusion injury and prevents myocardial ischemia while it provides the heart with more physiologic condition for duration of operation. This can be useful method for high-risk valvular patients ( )
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