Beating-heart mitral valve surgery in patients with poor left ventricular function.
OBJECTIVE
Mitral valve surgery in the presence of poor left ventricular (LV) function is associated with higher mortality. One surgeon's (S. K. N.) evolving practice of mitral valve surgery on the beating heart using normothermic cardiopulmonary bypass (CPB) in a cohort of patients is described.


METHODS
Between July 2000 and December 2002, 23 patients (13 men, 10 women; mean age 68.6 +/- 4.8 years; range: 54-81 years) with mitral regurgitation and LV ejection fraction <30% undergoing isolated mitral valve repair (n = 4) or replacement (n = 19) were investigated. All patients received maximal drug therapy. Among patients, 17 were in NYHA class III, and six in class IV.


RESULTS
The mean duration of follow up was 17 +/- 14 months, and was complete for all survivors. The visual field of the on-pump beating heart was equal to that of conventional valvular surgery, and technical accuracy was not compromised. The mean ICU and hospital stays were 2.4 +/- 1.3 days and 8.9 +/- 2.6 days, respectively. Mean CPB time was 74.3 +/- 14.8 min. Thirty-day mortality was significantly lower (8.7%) when compared to mean Euroscore-predicted mortality for this high-risk group (16.9%; p <0.001). The medium-term one- and two-year survivals were 87% and 78%, respectively. Mean NYHA class was improved, from 3.6 +/- 0.5 preoperatively to 1.9 +/- 0.7 at follow up (p = 0.037).


CONCLUSIONS
On-pump, beating-heart mitral valve surgery is a good option in patients with poor LV function, and is advantageous as conditions for the heart are more physiological with a beating tonus than with cardioplegia.
Ghosh
Sudip
S
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK. sudip.ghosh@talk21.com
Jutley
Rajwinder S
RS
Wraighte
Philip
P
Shajar
Matloubb
M
Naik
Surendra K
SK
D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass; D003131:Combined Modality Therapy; D001026:Coronary Artery Bypass; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D013318:Stroke Volume / Q000502:physiology; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome; D006113:United Kingdom; D018487:Ventricular Dysfunction, Left / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*