Noncardioplegic surgery for ischemic mitral regurgitation

Area of Science:

• Cardiovascular Surgery
• Cardiac Surgery
• Heart Valve Repair and Replacement

Background:

• Ischemic mitral regurgitation (MR) presents significant surgical challenges, particularly in patients with reduced ejection fraction (EF).
• Traditional surgical approaches may be limited in specific patient populations, necessitating alternative techniques.

Purpose of the Study:

• To evaluate the safety and efficacy of non-cardioplegic surgery for ischemic MR.
• To assess clinical outcomes, including mortality and morbidity, in patients undergoing this procedure.

Main Methods:

• Twenty-seven patients with ischemic MR underwent surgery involving coronary artery bypass grafting (CABG) followed by mitral valve repair or replacement.
• The procedure was performed under ventricular fibrillation (VF) with intermittent aortic cross-clamping and moderate hypothermia.
• The mitral procedure was conducted via a right-sided left atriotomy, with the heart perfused through native coronary arteries and CABG grafts.

Main Results:

• Hospital mortality was 3.7% (1 death in 27 patients).
• Mean ejection fraction (EF) improved from less than 30% preoperatively to 48% at hospital discharge.
• Low rates of prolonged intra-aortic balloon pump (IABP) support and mechanical ventilation were observed.

Conclusions:

• Non-cardioplegic surgery for ischemic MR is associated with acceptable mortality and morbidity.
• This technique offers a viable alternative, particularly when aortic clamping is undesirable.
• Extended periods of ventricular fibrillation did not correlate with adverse clinical outcomes.