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Published on: March 26, 2018
Beating-heart valve surgery: A systematic review
Kareem Salhiyyah1, David Taggart
1Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Trust, London, UK. kareemsal@doctors.org.uk
Insights
Beating-heart continuous coronary perfusion (BHCCP) in valve surgery shows no advantage over cardioplegic arrest, despite potential benefits in reducing myocardial injury. High-quality trials are needed to confirm its role.
Area of Science:
- Cardiovascular Surgery
- Cardiac Surgery Techniques
Background:
- Beating-heart continuous coronary perfusion (BHCCP) is proposed as an alternative to cardioplegic arrest in valve surgery.
- Potential benefits include avoiding cardioplegia and ischemic reperfusion injury, particularly in complex procedures like mitral valve repair.
Purpose of the Study:
- To systematically review the evidence comparing the efficacy of BHCCP versus cardioplegic arrest in valve surgery.
Main Methods:
- A systematic review of 39 reports was conducted.
- Analysis included assessment of study quality and evidence levels; only two reports were randomized controlled trials.
Main Results:
- Studies were generally of poor quality with low evidence levels.
- BHCCP demonstrated acceptable mortality and morbidity but no superiority over cardioplegic arrest.
- Weak evidence suggests BHCCP may reduce myocardial injury markers.
Conclusions:
- BHCCP is a potential operative strategy in valve surgery with possible benefits for myocardial injury.
- A high-quality, prospective randomized controlled trial is necessary to define the precise role of BHCCP in complex valve surgery.
Abstract:
Beating-heart continuous coronary perfusion (BHCCP) has been promoted as an alternative to the technique of cardioplegic arrest in valve surgery. Its potential advantage is the elimination of cardioplegia and the corollary risk of ischemic reperfusion injury. The use of CCP has been recommended especially when performing more complex operations, such as mitral valve repair, and particularly as surgeons become more familiar with beating-heart coronary surgery. We conducted a systematic review to assess the strength of the evidence supporting the efficacy of BHCCP compared to cardioplegia in valve surgery. Thirty nine reports were identified. Of these, only two were randomized control trials. Overall the studies were generally of poor quality and had a low evidence level. In those studies, mortality and major morbidity from BHCCP were within acceptable levels, nevertheless, there was no advantage over cardioplegic arrest. On the other hand there is weak evidence that it may reduce functional and biochemical markers of myocardial injury. In conclusion, BHCCP is an operative strategy in valve surgery with some potential benefits. There is, however a need for a high quality, prospective, randomized control trial to establish the exact role for BHCCP in complex valve surgery.
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