title: Beating heart continuous coronary perfusion for valve surgery: what next for clinical trials?
abstract: Prior to the introduction of cardioplegia, beating heart continuous coronary perfusion (BHCCP) was the only available method of myocardial protection. Currently, cardiac surgery on cardiopulmonary bypass with cardioplegic arrest is the gold standard strategy. Cardioplegic arrest provides an easier and safer way to operate on a still heart. It enables the performance of a broader range of cardiac procedures, and avoids the potential difficulties of continuous perfusion on a beating heart. Despite the overall effectiveness and safety of cardioplegia, some adverse effects remain, mainly due to the insult of ischemia, which results in ischemic reperfusion injury. As a result BHCCP has seen a revival as an alternative to cardioplegia for performing complex valvular surgery. Increasing experience reporting safety and efficacy of BHCCP is being published. However, despite the reported advantages, current available evidence validating safety and efficacy of BHCCP is controversial. This article provides an overview of BHCCP highlighting the current best available evidence supporting this strategy, concerns, controversies and potential areas for further research.
authors.affiliation: Department of Cardiothoracic Surgery, Harefield Hospital, Royal Brompton & Harefield NHS Trust, Hill End Road, Harefield, London, UB9 6JH, UK. kareemsal@doctors.org.uk
authors.forename: Kareem
authors.initials: K
authors.lastname: Salhiyyah
authors.forename: Shahzad G
authors.initials: SG
authors.lastname: Raja
authors.forename: Hiba
authors.initials: H
authors.lastname: Akeela
authors.forename: John
authors.initials: J
authors.lastname: Pepper
authors.forename: Mohamed
authors.initials: M
authors.lastname: Amrani
mesh_terms: D002986:Clinical Trials as Topic / Q000379:methods*; D001026:Coronary Artery Bypass / Q000379:methods; D006324:Heart Arrest, Induced / Q000009:adverse effects / Q000379:methods*; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000601:surgery; D017380:Hypertrophy, Right Ventricular / Q000601:surgery; D015425:Myocardial Reperfusion / Q000009:adverse effects / Q000379:methods*; D012307:Risk Factors; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right