Beating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits?

Myocardial and pulmonary ischemia during cardiopulmonary bypass is associated with cardiac and pulmonary dysfunction that may result in poor outcomes after cardiac surgery. Beating heart valve surgery, utilizing continuous coronary perfusion with warm oxygenated blood, together with continuous pulmonary artery perfusion and alveolar ventilation during cardiopulmonary bypass, represents an emerging and exciting novel strategy for myocardial and pulmonary protection. In this article, we present preliminary clinical results, as well as basic and clinical evidence, indications, contraindications and limitations of these new evolving techniques.