Mitral valve repair or replacement on the beating heart

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Repair and Replacement
• Off-Pump Coronary Artery Bypass Grafting

Background:

• Advancements in beating heart (off-pump) coronary artery bypass grafting (CABG) have enabled consideration of mitral valve procedures on a beating heart.
• This includes the possibility of performing mitral valve repairs and replacements concurrently with or independently of CABG.

Purpose of the Study:

• To evaluate the feasibility and outcomes of performing mitral valve surgery on a beating heart, with or without concomitant CABG.
• To assess the safety and efficacy of this approach in high-risk patients with compromised left ventricular function.

Main Methods:

• Coronary artery bypass grafting (CABG) was performed first on the beating heart without cardiopulmonary bypass when feasible.
• For valve procedures, the aorta was cross-clamped while maintaining beating-heart status via continuous warm, oxygenated blood coronary-sinus perfusion.

Main Results:

• The technique was applied to 23 patients with extremely low ejection fractions (78% NYHA class 4, 17% NYHA class 3).
• Procedures included mitral-tricuspid (11), mitral-aortic (7), mitral-tricuspid CABG (1), and mitral-aortic CABG (4).
• Total early mortality was 13% (3/23), with non-cardiac causes in two in-hospital deaths and one late death from prosthetic valve endocarditis.

Conclusions:

• Key advantages include myocardial perfusion, reduced cardiac workload, absence of reperfusion injury, and the ability to test mitral valve repair under physiological conditions.
• This beating-heart approach is a viable option for valve operations or combined procedures in high-risk patients with low ejection fractions.