Mitral Valve Replacements Under On-Pump Beating Heart and Lung Perfusion/Ventilation Using a Minithoracotomy: An Experience with 11 Cases

Authors

  • Ansheng Mo
  • Zhaoke Wen
  • Hui Lin
  • Changchao Lu
  • Shengjin Liang

DOI:

https://doi.org/10.1532/HSF98.20121013

Abstract

Background: The primary aims of minimally-invasive cardiac valve surgery are to lessen the impact of the incision, extracorporeal circulation, myocardial ischemia, and pulmonary ischemia, to obtain satisfactory therapeutic results, and to allow a quicker rehabilitation. In this study, the feasibility of minimally-invasive mitral valve replacements without ascending aorta and vena cava cross-clamping under beating heart was evaluated by surveying 11 patients.

Methods: Preoperative risk factors, intraoperative techniques, and postoperative complications were surveyed and evaluated for one year (April 1, 2009 to March 30, 2010) in 11 patients who had undergone beating-heart mitral valve replacement surgery at The People's Hospital of Guangxi Zhuang Autonomous Region. Minithoracotomy and femoral arterial cannulation procedures were used in the surgeries for cardiopulmonary bypass (CPB) without ascending aorta and vena cava cross-clamping.

Results: The operations were performed successfully in all 11 patients. The CPB time was 52.80 ± 11.36 minutes; the mean postoperative mechanical ventilation assistance time was 8.20 ± 2.84 hours; and the mean transfusion volume of red cells was 2.20 ± 1.04 units. There were no cerebral complications, no periprosthetic leakage, no occurrence of permanent high-degree atrioventricular blockage, and no mortality.

Conclusion: Mitral valve replacement on the beating heart using a minithoracotomy and femoral arterial cannulation for CPB without ascending aorta and vena cava crossclamping under pulmonary ventilation is feasible. A larger number of patients are required to further characterize the efficacy and safety of this procedure.

References

Friedman M, Sellke FW, Wang SY, Weintraub RM, Johnson RG. 1994. Parameters of pulmonary injury after total or partial cardiopulmonary bypass. Circulation 90:262-8.nGologorsky E, Macedo FI, Salerno TA. 2011. Beating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits? Expert Rev Cardiovasc Ther 9:927-37.nHewson JR, Shaw M. 1983. Continuous airway pressure with oxygen minimizes the metabolic lesion of "pump lung." Can Anaesth Soc J 30:37-47.nHui H, Wei H, Tangwei L, et al. 2001. Aortic and mitral valve replacement with retrograde perfusion in the beating heart. Chin Med J (Engl) 114:1180-3.nLiebold A, Keyl C, Birnbaum DE. 1999. The heart produces but the lungs consume proinflammatory cytokines following cardiopulmonary bypass. Eur J Cardiothorac Surg 15:340-5.nLiu Y, Wang Q, Zhu X, et al. 2000. Pulmonary artery perfusion with protective solution reduces lung injury after cardiopulmonary bypass. Ann Thorac Surg 69:1402-7.nMacedo FI, Gologorsky E, Salerno TA. 2011. Beating-heart valve surgery: is the introduction of lung perfusion/ventilation the next step? Future Cardiol 7:61-7.nMassoudy P, Piotrowski JA, van de Wal HC, et al. 2003. Perfusing and ventilating the patient's lungs during bypass ameliorates the increase in extravascular thermal volume after coronary bypass grafting. Ann Thorac Surg 76:516-21; discussion 521-2.nMo A, Lin H, He W, Feng X. 2005. Clinical research of lung protection in heart surgery on beating heart and mild hypothermia CBP. Guangxi Med J 27:795-8.nMo A, Lin H, Wen Z, Lu W, Long X, Zhou Y. 2008. Efficacy and safety of on-pump beating heart surgery. Ann Thorac Surg 86:1914-8.nRichter JA, Meisner H, Tassani P, Barankay A, Dietrich W, Braun SL. 2000. Drew-Anderson technique attenuates systemic inflammatory response syndrome and improves respiratory function after coronary artery bypass grafting. Ann Thorac Surg 69:77-83.nSiepe M, Goebel U, Mecklenburg A, et al. 2008. Pulsatile pulmonary perfusion during cardiopulmonary bypass reduces the pulmonary inflammatory response. Ann Thorac Surg 86:115-22.nSievers HH, Freund-Kaas C, Eleftheriadis S, et al. 2002. Lung protection during total cardiopulmonary bypass by isolated lung perfusion: preliminary results of a novel perfusion strategy. Ann Thorac Surg 74:1167-72; discussion 1172.nSuzuki T, Fukuda T, Inoue Y, Aki A, Cho Y. 1997. Effectiveness of continuous pulmonary perfusion during total cardiopulmonary bypass to prevent lung reperfusion injury. Nippon Kyobu Geka Gakkai Zasshi 45:31-6.nSuzuki T, Fukuda T, Ito T, Inoue Y, Cho Y, Kashima I. 2000. Continuous pulmonary perfusion during cardiopulmonary bypass prevents lung injury in infants. Ann Thorac Surg 69:602-6.nSuzuki T, Ito T, Kashima I, Teruya K, Fukuda T. 2001. Continuous perfusion of pulmonary arteries during total cardiopulmonary bypass favorably affects levels of circulating adhesion molecules and lung function. J Thorac Cardiovasc Surg 122:242-8.nTütün U, Parlar AI, Altinay L, et al. 2011. Does on-pump normothermic beating-heart valve surgery with low tidal volume ventilation protect the lungs? Heart Surg Forum 14:E297-301.nWan S, DeSmet JM, Barvais L, Goldstein M, Vincent JL, LeClerc JL. 1996. Myocardium is a major source of proinflammatory cytokines in patients undergoing cardiopulmonary bypass. J Thorac Cardiovasc Surg 112:806-11.nWang J, Liu H, Salerno TA, et al. 2009. Alternate antegrade/retrograde perfusion: an effective technique to preserve hypertrophied hearts during valvular surgery. Eur J Cardiothorac Surg 35:69-76.nWang J, Liu H, Xiang B, et al. 2006. Keeping the heart empty and beating improves preservation of hypertrophied hearts for valve surgery. J Thorac Cardiovasc Surg 132:1314-20.nZheng JH, Xu ZW, Wang W, et al. 2004. Lung perfusion with oxygenated blood during aortic clamping prevents lung injury. Asian Cardiovasc Thorac Ann 12:58-60.n

Published

2012-06-14

How to Cite

Mo, A., Wen, Z., Lin, H., Lu, C., & Liang, S. (2012). Mitral Valve Replacements Under On-Pump Beating Heart and Lung Perfusion/Ventilation Using a Minithoracotomy: An Experience with 11 Cases. The Heart Surgery Forum, 15(3), E133-E135. https://doi.org/10.1532/HSF98.20121013

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