Beating-heart valvular surgery with continuous warm blood perfusion may offer an alternative myocardial protection strategy for patients with severely reduced ejection fraction.
Case success with continuous warm perfusion in low-EF surgery is hypothesis-generating; should not yet change practice.
Cardioplegic arrest of the severely compromised ventricle may make weaning from cardiopulmonary bypass problematic. We report a novel approach to myocardial protection in a patient requiring multi-valve surgery who had an ejection fraction of 15%. Warm oxygenated blood was infused continuously both antegrade and retrograde during aortic valve replacement and mitral and tricuspid valve repair. Adequacy of perfusion was confirmed by the absence of electrocardiographic changes. Clinical improvement suggests that this strategy of myocardial protection warrants further investigation.
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Kaplon et al. (2002) studied this question.
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