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.

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