PMID- 11074978
OWN - NLM
STAT- MEDLINE
DCOM- 20060511
LR  - 20061115
IS  - 1098-3511 (Print)
IS  - 1098-3511 (Linking)
VI  - 3
IP  - 3
DP  - 2000
TI  - Mitral valve repair or replacement on the beating heart.
PG  - 232-7
AB  - BACKGROUND: Beating heart (off-pump) coronary artery bypass grafting (CABG) 
      techniques have led us to consider the possibility of performing mitral valve 
      repairs and replacements (with or without CABG) on the beating heart. METHODS: If 
      CABG had to be performed in addition to the valve procedure, CABG was done first 
      on the beating heart without cardiopulmonary bypass, if possible. For the valve 
      procedure, the aorta was cross-clamped and the beating-heart status was 
      maintained throughout the whole procedure with continuous, warm, oxygenated blood 
      coronary-sinus perfusion. RESULTS: We used this technique in 23 patients with 
      extremely low ejection fractions, 78% of whom were in New York Heart Association 
      (NYHA) class 4 and 17% of whom were in New York Heart Association (NYHA) class 3. 
      The procedures were: mitral-tricuspid (11 patients), mitral-aortic (7 patients), 
      mitral-tricuspid CABG (1 patient), and mitral-aortic CABG (4 patients). The total 
      early mortality was 13% (3 of 23 patients). Two were in-hospital deaths. One 
      patient with triple-vessel disease and acute mitral insufficiency (AMI) on intra 
      aortic balloon pump had been operated on six days after AMI. The cause of death 
      was systemic meticillin resistant staphylococcus aureus infection. (Eight days 
      prior to our operation, arthrodesis of the talocrural joint was performed by an 
      orthopedic surgeon.) The other death was a female patient who was operated on 
      after previous multiple cerebrovascular infarctions (CVIs) (cause of the death 
      was CVI). In addition, one patient died one month after the operation because of 
      prosthetic valve endocarditis on aortic and mitral valves (silver-coated silzone 
      aortic and mitral valves were implanted because of chronic latent asymptomatic 
      tibial osteitis). None of these deaths were cardiac related. CONCLUSIONS: The 
      main advantages of beating heart surgery are: 1) the perfused myocardial muscle, 
      2) the heart not doing any work, 3) no reperfusion injury, 4) the possibility for 
      ablation of atrial fibrillation on the beating heart, and 5) testing of the 
      mitral valve repair is done in real physiologic conditions in the state of left 
      ventricle beating tonus. The procedure could be the procedure of choice for the 
      valve operation or combined operations in high-risk patients with low ejection 
      fractions.
FAU - Gersak, B
AU  - Gersak B
AD  - Department of Cardiovascular Surgery, University Medical Center, Ljubljana, 
      Slovenia. borut.gersak@maat.si
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PL  - United States
TA  - Heart Surg Forum
JT  - The heart surgery forum
JID - 100891112
SB  - IM
MH  - Adult
MH  - Aged
MH  - Female
MH  - Follow-Up Studies
MH  - Heart Valve Prosthesis Implantation/*methods
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Mitral Valve Insufficiency/physiopathology/*surgery
MH  - Stroke Volume
MH  - Treatment Outcome
EDAT- 2000/11/14 00:00
MHDA- 2006/05/12 09:00
CRDT- 2000/11/14 00:00
PHST- 2000/06/08 00:00 [accepted]
PHST- 2000/11/14 00:00 [pubmed]
PHST- 2006/05/12 09:00 [medline]
PHST- 2000/11/14 00:00 [entrez]
PST - ppublish
SO  - Heart Surg Forum. 2000;3(3):232-7.