On-pump beating heart versus hypothermic arrested heart valve replacement surgery

Area of Science:

• Cardiovascular Surgery
• Neurology
• Anesthesiology

Background:

• Prosthetic heart valve replacement involves comparing neurological parameters between two surgical techniques.
• Techniques include cardioplegic arrest under hypothermic cardiopulmonary bypass (CPB) versus beating heart on normothermic bypass.
• The beating heart technique may or may not involve aortic cross-clamping and avoids cardioplegic arrest.

Purpose of the Study:

• To compare neurological monitoring results in patients undergoing prosthetic heart valve replacement.
• To evaluate differences between conventional hypothermic arrested heart surgery and on-pump beating heart techniques.
• To assess clinical outcomes across different surgical approaches.

Main Methods:

• Fifty valvular surgery patients were randomized into three groups: beating heart without aortic cross-clamp, beating heart with aortic cross-clamp and retrograde coronary sinus perfusion, and conventional hypothermic arrested heart surgery.
• Neurological parameters were monitored using two-channel electroencephalography (EEG) and bispectral monitoring (BIS).
• Cerebral blood flow was measured using transcranial Doppler (TCD) in the middle cerebral artery (MCA).

Main Results:

• Reductions in spectral edge frequency, BIS, or TCD flow velocity were observed in some patients across all groups, but isoelectric silence (BIS or EEG reaching zero) did not occur.
• No patient experienced significant neurological events during surgery.
• Postoperative gross neurological examinations were normal for all patients.

Conclusions:

• On-pump beating heart valve replacement surgery shows no neurological monitoring differences compared to hypothermic arrested heart surgery.
• No significant differences in clinical outcomes were observed among the compared surgical groups.
• Both surgical approaches appear equally safe from a neurological and clinical outcome perspective.