Beating heart valve surgery in patients with low left ventricular ejection fraction

Patients with very low left ventricular ejection fraction (LVEF) are at high risk for valve surgery. We herein present our experience with beating heart valve surgery in such patients.

From May 2000 to October 2006, 346 consecutive patients underwent beating heart valve surgery. Of these, 50 patients had LVEF <30%: 7 had LVEF 21 to 29%, 34 had LVEF <20%, and 9 had LVEF <10%. Mean age was 57.44 +/- 12.45 years (range 28 to 85 years). There were 40 males (80%) and 10 females (20%).

Isolated mitral valve (MV) and aortic valve replacements were performed in 11 (22%) and 10 (20%) of patients, respectively. Fourteen (28%) patients underwent combined coronary artery bypass grafting and valve replacements. MV repairs were performed; 13 (26%) patients and 2 (4%) patients had combined MV replacements and tricuspid repairs. Mean hospital stay was 15.37 +/- 13.12 days (range 3 to 55 days). Overall early mortality (<30 days) was 6% (three patients) and one patient (2%) died late (>30 days).

Beating heart valve surgery in patients with poor LVEF yields results similar to conventional surgery using cardioplegia. Additional studies are needed to fully evaluate the potential benefits of this method of myocardial perfusion for this high-risk group of patients.