[Is left ventricular venting necessary in open heart surgery?].

Area of Science:

• Cardiovascular Surgery
• Cardiac Anesthesia
• Cardiopulmonary Bypass

Background:

• Left ventricular venting is a common practice during open heart surgery.
• The necessity and benefits of left ventricular venting remain debated.
• Potential risks include myocardial injury and distension.

Purpose of the Study:

• To compare surgical outcomes and clinical courses of patients undergoing open heart procedures with and without left ventricular venting.
• To clarify the benefits of left ventricular venting in adult patients with acquired heart diseases.

Main Methods:

• Retrospective comparison of 19 patients with venting versus 44 patients without venting.
• All patients underwent open heart surgery for acquired heart diseases.
• Surgical results and clinical courses were analyzed.

Main Results:

• Hospital mortality was not significantly different (10.5% vent vs. 2.3% no-vent).
• No significant differences in low output syndrome, spontaneous defibrillation, IABP support, prolonged catecholamine infusion, or ventricular arrhythmias.
• Cardiac index was significantly higher 6 hours postoperatively in the no-vent group.
• Left atrial pressure remained below 10 mmHg in the no-vent group when central venous pressure was below 7 mmHg.

Conclusions:

• Open heart surgery without left ventricular venting is feasible and safe.
• Maintaining low central venous pressure (below 6-7 mmHg) during cardiopulmonary bypass prevents left ventricular distension and myocardial injury.
• Left ventricular venting may not be necessary in all adult open heart procedures for acquired heart diseases.