Redo valve surgery with on-pump beating heart technique.

Area of Science:

• Cardiovascular Surgery
• Cardiac Valve Surgery
• Minimally Invasive Cardiac Surgery

Background:

• Reoperative cardiac valve surgery is increasingly common.
• Redo valve surgery presents higher risks than primary procedures.
• The beating heart technique offers a potential alternative to traditional cardioplegic arrest.

Purpose of the Study:

• To evaluate the safety and efficacy of beating heart technique for mitral and aortic valve re-replacement.
• To present immediate and mid-term outcomes of this approach in redo valve surgery patients.

Main Methods:

• Prospective study of 26 consecutive patients undergoing redo valve surgery.
• Utilized normothermic bypass on a beating heart without aortic cross-clamping for mitral valve procedures.
• Employed retrograde coronary sinus normothermic blood perfusion during aortic valve procedures with aortic cross-clamping.

Main Results:

• No operative mortality observed in 26 patients (mean age 50 years).
• Procedures included 20 mitral, 4 aortic, and 2 double valve replacements, with 53.8% for prosthetic valve dysfunction.
• Low complication rates: 3.8% pulmonary, 3.8% low cardiac output, 7.7% re-exploration for bleeding.

Conclusions:

• Normothermic on-pump beating heart valve replacement is a safe alternative to cardioplegic arrest in high-risk redo surgery.
• This technique demonstrates lower complication and perioperative mortality rates compared to conventional surgery.
• The beating heart approach preserves cardiac physiology throughout the procedure.