Beating Heart Mitral Valve Replacement Research Articles

Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function

Mid-Term Outcomes of Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function

Clampless Beating Heart Mitral Valve Replacement in Dilated Cardiomyopathy

Clampless Beating Heart Mitral Valve Replacement in Dilated Cardiomyopathy

Beating Heart Mitral Valve Replacement in Secondary Mitral Regurgitation with Poor Left Ventricular Function Literature Review

The poor early and mid-term prognosis of secondary mitral regurgitation (MR) with impaired left ventricular function after restrictive annuloplasty with cardioplegic arrest has opened the way for transcatheter repair. The indication for surgery is only incontestable when concomitant coronary revascularization is required. Beating heart mitral valve surgery without aortic clamping has been promoted as an alternative to the technique of cardioplegic arrest. Its potential advantage is the elimination of ischemic reperfusion injury and its impact on myocardial function. On the other hand a randomized study confirmed that for ischemic MR, mitral valve replacement (MVR) reduces the rate of MR recurrence and re-hospitalization compared to restrictive annuloplasty. We performed a review of the literature to assess the strength of the evidence supporting the efficacy of beating heart MVR without aortic clamping compared to the conventional technique for secondary MR with poor left ventricular function. In a randomized study of patients with chronic severe mitral regurgitation and left ventricular dysfunction, beating heart MVR was associated with better LV function, reduction of cardiac enzymes early postoperatively, reduced duration of mechanical ventilation, and ICU than MVR using warm blood cardioplegic arrest. This together with the absence of related perioperative mortality and the major complications suggests that this technique is safe and beneficial to LV function. This finding has been verified by a multitude of other observational studies which have shown that the benefit of this technique is more palpable in cases of redo mitral surgery or in cases of MR with poor left ventricular function.

Sustitución valvular mitral por toracotomía posterolateral izquierda a corazón latiendo

Introduction and objectivesThe case concerns a 34-year-old man with Marfan syndrome and Pectus Excavatum that has been previously operated on for an ascending aortic aneurysm and aortic regurgitation using the David I technique in 2007. The patient currently has severe mitral regurgitation due to rupture of the anterior chordae leaflet. The objective is to demonstrate that left posterolateral thoracotomy is a feasible alternative in certain selected cases for the treatment of mitral valve pathology. MethodsGiven the anatomical characteristics of the patient, and previous cardiac surgery, posed the question of what would be the best approach for this case. After a review of the literature and expert consultations, it was decided to perform a mitral valve replacement via left posterolateral thoracotomy. To do this, after left posterolateral thoracotomy and cannulation at the level of the descending thoracic aorta and left common femoral vein (Seldinger), extracorporeal circulation was started. Given the impossibility of aortic clamping, it was decided to perform beating heart mitral valve replacement in a CO2 environment. To do this, a left atriotomy was performed and, using various recovery aspirators, an acceptable view of the mitral valve was achieved. I was decided to replace it, due to the technical difficulties that a valve repair would entail. ResultsThe mitral replacement was successfully performed by transoesophageal echocardiography. ConclusionsLeft posterolateral thoracotomy may be an alternative for patients with concomitant pathologies that cause displacement of the heart towards the left hemithorax.

Beating-heart versus conventional mitral valve replacement; a randomized clinical trial

Background: Various methods have been developed to overcome the deleterious effects of ischemia/ reperfusion injury that occurs after cardioplegic arrest. The aim of the study was to assess the safety, efficacy, and applicability of the beating-heart mitral valve replacement (MVR) compared to the conventional MVR.
 Methods: Forty patients scheduled for mitral valve replacement were randomly assigned into two groups, conventional MVR as the control group (n= 20) and beating-heart MVR with continuous antegrade coronary perfusion as the study group (n=20). Three patients in the beating-heart group were converted to the conventional technique because of the blood-flooded field and excluded from the analysis.
 Results: The preoperative clinical and echocardiographic variables were comparable between both groups. There was no significant difference between both groups regarding cardiopulmonary bypass time (79.4± 14 vs. 75.7± 10.9 minutes; p= 0.398) and total operative time (200± 55.6 vs. 183.9± 67.5 min; p= 0.458) in the conventional and beating-heart group, respectively. Serum troponin I level was significantly higher in the conventional MVR group 6 hours postoperatively (4.9±4 vs. 2.7±1.2 ng/ml; p= 0.036), while there was no significant difference between both groups regarding total CK and CK-MB (p= 0.565 & 0.597 respectively). Eight patients (44%) in the conventional MVR group needed inotropic support compared to 3 patients (19%) in the beating-heart MVR group (P = 0.11). There was no operative mortality or major morbidity in both groups. At 6-months follow-up, there was no difference in NYHA class (1.3±0.3 vs. 1.2±0.3; p= 0.336) and the ejection fraction (60.0±6.3 vs. 63.2±6 %; p= 0.139) in the conventional vs. beating-heart group. 
 Conclusion: Beating-heart MVR is a safe alternative to the conventional method with comparable outcomes. There is a relatively blood-filled field compared to the conventional technique.

Beating heart mitral valve replacement combined with minimally invasive myocardial revascularizationin patient with acute ischemic mitral insufficiency type II

Beating heart mitral valve replacement combined with minimally invasive myocardial revascularizationin patient with acute ischemic mitral insufficiency type II

Bypass Assisted Beating Heart Mitral Valve Replacement for Rheumatic Mitral Valve Disease with Moderate Left Ventricular Dysfunction: A Surgical Experience

Bypass Assisted Beating Heart Mitral Valve Replacement for Rheumatic Mitral Valve Disease with Moderate Left Ventricular Dysfunction: A Surgical Experience

On pump beating heart mitral valve replacement with protection of the mitral leaflets in poor ventricle patients

Abstract: Mitral valve replacement (MVR) in patients with severe mitral regurgitation and poor ventricle has a high mortality and morbidity. For such patients if mitral valve repair is not possible MVR can be performed with partial or complete protection of the mitral leaflets. Herein we report 2 patients with severe mitral regurgitation and poor ventricle (EF 20%– 25%). MVR was performed by complete protection of the both anterior and posterior mitral leaflets and using the on-pump beating heart technique.Levosemindan was administered to one of the patients on induction of anesthesia. Weaning from cardiopulpunary bypass was uneventful for the both patients. The postoperative course of the 2 patients was uneventful and they were discharged on the 5th and 6th days.

Mitral Valve Replacements Under On-Pump Beating Heart and Lung Perfusion/Ventilation Using a Minithoracotomy: An Experience with 11 Cases

The primary aims of minimally-invasive cardiac valve surgery are to lessen the impact of the incision, extracorporeal circulation, myocardial ischemia, and pulmonary ischemia, to obtain satisfactory therapeutic results, and to allow a quicker rehabilitation. In this study, the feasibility of minimally-invasive mitral valve replacements without ascending aorta and vena cava cross-clamping under beating heart was evaluated by surveying 11 patients. Preoperative risk factors, intraoperative techniques, and postoperative complications were surveyed and evaluated for one year (April 1, 2009 to March 30, 2010) in 11 patients who had undergone beating-heart mitral valve replacement surgery at The People's Hospital of Guangxi Zhuang Autonomous Region. Minithoracotomy and femoral arterial cannulation procedures were used in the surgeries for cardiopulmonary bypass (CPB) without ascending aorta and vena cava cross-clamping. The operations were performed successfully in all 11 patients. The CPB time was 52.80 ± 11.36 minutes; the mean postoperative mechanical ventilation assistance time was 8.20 ± 2.84 hours; and the mean transfusion volume of red cells was 2.20 ± 1.04 units. There were no cerebral complications, no periprosthetic leakage, no occurrence of permanent high-degree atrioventricular blockage, and no mortality. Mitral valve replacement on the beating heart using a minithoracotomy and femoral arterial cannulation for CPB without ascending aorta and vena cava crossclamping under pulmonary ventilation is feasible. A larger number of patients are required to further characterize the efficacy and safety of this procedure.

Comparison of Neurocognitive Functions after Beating-Heart Mitral Valve Replacement without Aorta Cross-Clamping and after Standard Mitral Valve Replacement with Cardioplegic Arrest

The aim of this study was to compare the postoperative long-term neurocognitive functions of patients who under-went beating-heart mitral valve replacement on cardiopulmonary bypass (CPB) without aorta cross-clamping with those of patients who underwent mitral valve replacement via the classic method. The study group included 25 randomly selected patients who underwent beating-heart mitral valve surgery. During the same period, 25 patients were randomly selected as controls to undergo mitral valve replacement procedures via the standard ascending aorta-cannulation technique. The clinical and postoperative (2 months) neurocognitive functional data of both groups were compared. Neurologic deficit was observed in neither group during the postoperative period. There were no statistically significant differences between the control and the study groups with respect to Hospital Anxiety and Depression Scale (HADS) results (HADS: anxiety, P = .653; HADS: depression, P = .225), in the right hemispheric cognitive function test results (Raven's Standard Progressive Matrices [RSPM] and Line Orientation Test [LOT] tests: RSPM, P = .189), and in the left hemispheric cognitive function test results (the Ray Auditory Verbal Learning [RAVL] and Stroop Color-Word Test [SCWT] tests: SCWT 1 time, P = .300; SCWT 2 time, P = .679; SCWT 3 time, P = .336; SCWT 4 time, P = .852; SCWT 5 time, P = .416; RAVL total verbal learning, P = .167; RAVL immediate recall, P = .791; RAVL distraction trial, P = .199; RAVL retention, P = .174; RAVL delayed recall, P = .111; RAVL recognition, P = .282; SCWT 4 mistake, P = .306; SCWT 4 reform, P = .066; SCWT 5 mistake, P = .236; SCWT 5 reform, P = .301). The technique of mitral valve replacement with normothermic CPB without cross-clamping of the aorta may be safely used for the majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions.

Beating heart mitral valve replacement in a patient with a previous Bentall operation

Today, mitral valve replacement is performed under cardioplegic arrest with cross-clamping of the ascending aorta. In the case reported here, mitral valve replacement was performed with an on-pump beating heart technique without cross-clamping the aorta because of diffuse adhesion around the tube graft. A 36-year-old man had undergone a Bentall operation (aortic root replacement+coronary reimplantation) via median sternotomy because of type I aortic dissection 4 years previously in our cardiac center. He was admitted to the hospital complaining of palpitation and dyspnea on mild exertion. Transthoracic echocardiography study revealed third-degree mitral insufficiency. Mitral valve replacement was carried out through re-median sternotomy with an on-pump beating heart technique without crossclamping the aorta. On-pump beating heart mitral valve replacement without a cross-clamp offers a safe approach when excessive dissection is required to place a crossclamp on the ascending aorta.

Neurocognitive Functions after Beating Heart Mitral Valve Replacement without Cross-Clamping the Aorta

Although neurologic outcome after cardiac surgery is well-established, neurocognitive functions after beating heart mitral valve replacement still needs to be elucidated. The aim of this study was to compare preoperative and postoperative neurocognitive functions in patients who underwent beating heart mitral valve replacement on cardiopulmonary bypass without cross-clamping the aorta. The prospective study included 25 consecutive patients who underwent mitral valve replacement. The operations were carried out on a beating heart method using normothermic cardiopulmonary bypass without cross-clamping the aorta. All patients were evaluated preoperatively (E1) and postoperatively (at sixth day [E2] and second month [E3]) for neurocognitive functions. Neurologic deficit was not observed in the postoperative period. Comparison of the neurocognitive test results, between the preoperative and postoperative assessment for both hemispheric cognitive functions, demonstrated that no deterioration occurred. In the three subsets of left hemispheric cognitive function test evaluation, total verbal learning, delayed recall, and recognition, significant improvements were detected at the postoperative second month (E3) compared to the preoperative results (p = 0.005, 0.01, and 0.047, respectively). Immediate recall and retention were significantly improved within the first postoperative week (E2) when compared to the preoperative results (p = 0.05 and 0.05, respectively). The technique of mitral valve replacement with normothermic cardiopulmonary bypass without cross-clamping of the aorta may be safely used for majority of patients requiring mitral valve replacement without causing deterioration in neurocognitive functions.

Beating Heart Mitral Valve Replacement with a Bovine Pericardial Bioprosthesis for Treatment of Mitral Valve Dysplasia in a Bull Terrier

To describe an open, beating heart surgical technique and use of a bovine pericardial prosthetic valve for mitral valve replacement (MVR) in the dog. Clinical case report. Male Bull Terrier (17-month-old, 26 kg) with mitral valve dysplasia and severe regurgitation. A bovine pericardial bioprosthesis was used to replace the mitral valve using an open beating heart surgical technique and cardiopulmonary bypass. Successful MVR was achieved using a beating heart technique. Mitral regurgitation resolved and cardiac performances improved (left ventricular end-diastolic diameter decreased from 57.6 to 48.7 mm, and left atrium/aorta ratio returned to almost normal, from 1.62 to 1.19). Cardiopulmonary by-pass time and total surgical duration were decreased compared with standard cardioplegic techniques. Surgical recovery was uneventful and on echocardiography 6 months later valve function was excellent. Considering the technique advantages (no cardiac arrest, ischemic reperfusion injury, and hypothermia, or the need for aortic dissection and cannulation for administration of cardioplegic solution), short-term mortality and morbidity may be reduced compared with standard cardioplegic techniques. Based on experience in this dog, beating heart mitral valvular replacement is a seemingly safe and viable option for the dog and bovine pericardial prosthesis may provide better long-term survival than mechanical prostheses.