title: Multiple valve surgery with beating heart technique.
abstract: BACKGROUND
  Multiple valve surgery was performed utilizing beating heart technique through simultaneous antegrade/retrograde perfusion with blood. We herein report our experience with this technique in patients with multiple valve disease processes.
  
  
  METHODS
  Of 520 consecutive patients operated upon utilizing this method between 2000 and 2007, 59 patients underwent multiple valve surgery. Mean age was 54.2 +/- 13.8 years (range, 21 to 83) with 41 males (69.5%) and 18 females (30.5%). Double-valve and triple-valve operations were performed in 54 and 5 patients, respectively.
  
  
  RESULTS
  Of 32 mitral valve replacements, there were 30 biological (93.8%) and 2 mechanical (6.2%) mitral valves. Aortic valve replacement was performed in 25 patients: 22 (88%) with biological and 3 (12%) with mechanical prostheses. Two patients had mitral and tricuspid valve repair. The most common procedure was mitral valve replacement plus tricuspid valve repair (16 patients; 27.1%), mitral valve replacement plus aortic replacement (14 patients; 23.7%), and mitral valve repair plus tricuspid repair (13 patients; 22%). Concomitant coronary artery bypass grafting was performed in 7 (11.8%) of 59 patients. Mean hospital stay was 25.6 +/- 29.6 days (range, 3 to 195; median, 17). Early mortality (less than 30 days) occurred in 5 patients (8.4%), and late mortality (more than 30 days) occurred in 2 patients (3.4%). Reoperation for bleeding was needed in 5 patients (8.4%). Intra-aortic balloon pump was required preoperatively and postoperatively in 4 and 1 patients, respectively. Clinical and echocardiographic follow-up in 33 patients at 11.8 +/- 16.4 months (range, 1 to 80) showed preserved postoperative left ventricular ejection fraction. Three patients had perivalvular leaks on follow-up but required no surgery. Nineteen patients were lost to follow-up.
  
  
  CONCLUSIONS
  This study demonstrates the feasibility and safety of beating heart techniques in multiple valve operations. Further studies are needed to fully evaluate the potential benefits of this method of myocardial perfusion as a means to eliminate ischemia-reperfusion injury, and to preserve ventricular function in multiple valvular surgery.
authors.affiliation: Division of Cardiothoracic Surgery, University of Miami, Miller School of Medicine, and Jackson Memorial Hospital, Miami, Florida, USA.
authors.forename: Marco
authors.initials: M
authors.lastname: Ricci
authors.forename: Francisco Igor B
authors.initials: FI
authors.lastname: Macedo
authors.forename: Maria R
authors.initials: MR
authors.lastname: Suarez
authors.forename: Michael
authors.initials: M
authors.lastname: Brown
authors.forename: Julia
authors.initials: J
authors.lastname: Alba
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Salerno
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001705:Bioprosthesis; D002315:Cardiopulmonary Bypass / Q000379:methods; D015331:Cohort Studies; D047549:Coronary Artery Bypass, Off-Pump; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult