title: Initial experience with beating-heart single valve replacement surgery at the University Hospital of the West Indies, Kingston, Jamaica.
abstract: The objective of this study was to examine the consequences of performing single cardiac valve replacement procedures utilizing a beating-heart technique on typical patients presenting to the cardiothoracic surgery service for aortic or mitral valve replacement. Beating heart aortic (4) or mitral valve (1) replacement was performed on patients from July 2000 to November 2002. A stratified sample of five patients who underwent standard arrested-heart single valve replacement procedures between April 1997 and November 2002 was selected for retrospective comparison with the beating-heart group. Operative and post-operative variables were compared between the two groups of patients and subjected to statistical analysis. There was no statistical difference between the two groups with respect to age, pre- or post-operative New York Heart Association (NYHA) scores, cardiopulmonary bypass time, aortic cross-clamp time, intra-operative blood transfusion, or post-operative hospital stay. Post-operatively, in the beating heart group, ventilation time, mediastinal blood loss and requirements for inotropic drugs were significantly reduced (p = 0.0054), p = 0.0019 and 0 = 0.02 respectively) compared to the arrested-heart group. Single cardiac valve replacement surgery utilizing a beating heart technique may offer benefits to patients over traditional arrested-heart surgery. Post-operative blood loss, inotrope requirements and ventilation times are significantly reduced, possibly resulting in better recovery and potentially fewer complications in the post-operative period. There may be cost benefits, important in the context of healthcare delivery in developing nations. These early results suggest the need for a regional prospective randomized trial to compare beating-heart single valve replacement surgery with traditional techniques.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery, Radiology, Anaesthesia and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Kingston 7, Jamaica, West Indies. pabloram@cwjamaica.com
authors.forename: P S
authors.initials: PS
authors.lastname: Ramphal
authors.forename: R W
authors.initials: RW
authors.lastname: Irvine
authors.forename: A
authors.initials: A
authors.lastname: Wierenga
authors.forename: M
authors.initials: M
authors.lastname: Scarlett
authors.forename: C D
authors.initials: CD
authors.lastname: McGaw
mesh_terms: D000328:Adult; D001021:Aortic Valve / Q000601:surgery; D016009:Chi-Square Distribution; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006785:Hospitals, University; D006801:Humans; D007563:Jamaica; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome