title: Concomitant beating-heart mitral valve surgery and coronary artery bypass in patients with compromised ventricular function.
abstract: BACKGROUND
  : Surgical repair of mitral valve disease and concomitant coronary artery occlusive disease has high operative risk. Myocardial protection for protracted, complicated procedures is seminal to the overall operative outcome; specifically, preservation of left ventricular function.
  
  
  METHODS
  The authors conducted a retrospective review of 25 patients undergoing combined mitral valve repair/replacement (MVR) and coronary artery bypass surgery (CABG) using the beating-heart technique at the Miller/University of Miami School of Medicine. The CABG was performed without cardiopulmonary bypass support. During the mitral valve surgery the perfusion pressure was maintained at 80-90 mm Hg and the systemic temperature at 35-36ºC. The aorta was not cross-clamped.
  
  
  RESULTS
  : Twenty-five patients underwent MVR/CABG, including 7 patients with acute myocardial infarction. Preoperative echocardiograms revealed a mean ejection fraction (EF) of 41 ± 4.5%. One patient required a preoperative intraarterial balloon pump. An average of 2.12 ± 0.9 grafts and a total of 10 mitral valve repairs were performed. The average length of stay in the intensive care unit was 14 ± 1.8 days, and average hospitalization time was 23 ± 3. The mean postoperative EF was 41 ± 4.5%. The mortality in this patient group was 12 % (3/25) with a morbidity rate of 52% (13/25).
  
  
  CONCLUSIONS
  : The data suggest that the technique is safe and reproducible, and that it potentially has a short-term benefit on left ventricular function. Therefore, this particular technique may be efficacious in patients with compromised left ventricular function requiring a combined MVR/CABG.
authors.affiliation: From the Division of Cardiothoracic Surgery, Jackson Memorial Medical Center, Miller/University of Miami School of Medicine, Miami, FL, USA.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Luozzo
authors.forename: Pierluca
authors.initials: P
authors.lastname: Lombardi
authors.forename: Alberto
authors.initials: A
authors.lastname: Maldonado
authors.forename: Marco
authors.initials: M
authors.lastname: Ricci
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Salerno