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Beating heart continuous coronary perfusion for valve surgery: what next for clinical trials?
Kareem Salhiyyah1, Shahzad G Raja, Hiba Akeela
1Department of Cardiothoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Hill End Road, Harefield, London, UB9 6JH, UK. kareemsal@doctors.org.uk
Insights
Beating heart continuous coronary perfusion (BHCCP) is being re-evaluated as an alternative to cardioplegic arrest for complex cardiac surgery. While offering potential benefits, its safety and efficacy remain subjects of ongoing research and debate.
Area of Science:
- Cardiovascular Surgery
- Myocardial Protection Strategies
Background:
- Cardioplegic arrest is the current gold standard for cardiac surgery, offering a still heart for easier and safer procedures.
- Despite its effectiveness, cardioplegia can lead to ischemic reperfusion injury, prompting renewed interest in alternative methods.
Purpose of the Study:
- To provide an overview of beating heart continuous coronary perfusion (BHCCP) as an alternative myocardial protection strategy.
- To highlight current evidence, concerns, and controversies surrounding BHCCP for complex valvular surgery.
Main Methods:
- Review of existing literature and evidence supporting BHCCP.
- Analysis of reported safety and efficacy data for BHCCP in cardiac procedures.
Main Results:
- BHCCP was historically the primary method of myocardial protection before cardioplegia.
- Increasing reports suggest safety and efficacy of BHCCP for complex valvular surgery, but evidence remains controversial.
Conclusions:
- BHCCP is experiencing a revival for complex valvular surgery due to limitations of cardioplegia.
- Further research is needed to definitively validate the safety, efficacy, and address controversies surrounding BHCCP.
Abstract:
Prior to the introduction of cardioplegia, beating heart continuous coronary perfusion (BHCCP) was the only available method of myocardial protection. Currently, cardiac surgery on cardiopulmonary bypass with cardioplegic arrest is the gold standard strategy. Cardioplegic arrest provides an easier and safer way to operate on a still heart. It enables the performance of a broader range of cardiac procedures, and avoids the potential difficulties of continuous perfusion on a beating heart. Despite the overall effectiveness and safety of cardioplegia, some adverse effects remain, mainly due to the insult of ischemia, which results in ischemic reperfusion injury. As a result BHCCP has seen a revival as an alternative to cardioplegia for performing complex valvular surgery. Increasing experience reporting safety and efficacy of BHCCP is being published. However, despite the reported advantages, current available evidence validating safety and efficacy of BHCCP is controversial. This article provides an overview of BHCCP highlighting the current best available evidence supporting this strategy, concerns, controversies and potential areas for further research.
