Importance of venting the left ventricle in aortic valve surgery

Routine use of left ventricular vent is controversial in patients undergoing open heart surgery. However, surgeons use it during valvular surgery to maintain a dry field to make the operation easier. In addition it helps to prevent left ventricular distention during the critical period of rewarming and reperfusion, if ventricular function does not return immediately following the release of aortic cross clamp. In our country, patients present for valvular surgery at a very late stage and they often have severe left ventricular hypertrophy. This may affect the return of cardiac rhythm after the release of aortic cross clamp with progressive left ventricular distention. In the authors' experience, insertion of left ventricular vent through the apex is occasionally necessary to decompress the left ventricle as the left atrial vent usually fails to do so. This paper deals with retrospective analysis of the seven patients (out of a total of 395 patients who underwent valve surgery) who required insertion of left ventricular vent through the apex and reviews the beneficial effects of an apical left ventricular vent under refractory circumstances. It is recommended that insertion of left ventricular vent through apex should be strongly considered in patients having severe aortic valve disease with hypertrophied hearts, if cardiac rhythm in not restored with conventional management with left atrial vent and 3 to 5 DC shocks following the release of aortic cross clamp.