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[Mitral valve replacement under beating heart in 137 cases]

W He1, H Lin, M Chen

  • 1Department of Cardiac Surgery, First Affiliated Hospital of Guangxi Medical University, Nanning.

Zhonghua Wai Ke Za Zhi [Chinese Journal of Surgery]
|November 1, 1996
PubMed
Summary

This study presents a novel beating heart mitral valve replacement technique using extracorporeal circulation at mild hypothermia (31-35°C). The procedure demonstrated good postoperative outcomes, minimizing myocardial damage and complications in 137 patients.

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Area of Science:

  • Cardiovascular Surgery
  • Cardiac Anesthesia
  • Medical Device Design

Context:

  • Myocardial ischemia, hypoxia, and reperfusion injury are significant risks during cardiac surgery.
  • Traditional methods often involve cardioplegic arrest, increasing ischemic times.
  • Mitral valve disease, including stenosis and insufficiency, requires effective surgical intervention.

Purpose:

  • To evaluate the efficacy and safety of mitral valve replacement on a beating heart under mild hypothermia (31-35°C) using extracorporeal circulation.
  • To assess the feasibility of this technique in patients with rheumatic or congenital heart disease, including concurrent aortic insufficiency.
  • To introduce novel devices for air removal and perfusion during the procedure.

Summary:

  • A total of 137 patients underwent mitral valve replacement using a beating heart technique with extracorporeal circulation at mild hypothermia (31-35°C).

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  • Patients experienced controlled bradycardia (40-50 bpm) and mild hypothermia (nasal temperature 32±1°C).
  • Concurrent aortic insufficiency was managed by aortic valve replacement first under cold arrest, followed by mitral valve replacement on a beating heart. Tricuspid valve repair was also performed on a beating heart. Novel devices for left cardiac chamber air removal and aorta perfusion were utilized.

    • Impact:

    • The technique resulted in good postoperative prognoses, with reduced dopamine requirements and stable arterial pressure (9.5-10.5 kPa).
    • No cases of low cardiac output syndrome, acute renal failure, or severe arrhythmia were observed.
    • The overall mortality rate was low at 2.9% (4 deaths) due to infection and coagulation issues, indicating the safety and effectiveness of this minimally invasive approach.