Key result
Mitral valve replacement using a beating heart technique reduced the incidence of low cardiac output status (P=0.007) and improved early postoperative LV function compared to warm cardioplegia.
Why the study?
The study was conducted to evaluate whether mitral valve replacement could be accomplished on a beating heart rather than with cardioplegic arrest in patients with chronic severe mitral regurgitation and left ventricular dysfunction.
Does mitral valve replacement using beating heart technique improve postoperative LV function and clinical outcomes in patients with chronic severe mitral regurgitation and left ventricular dysfunction?
RCT (n=60)
prospectively randomized
Does mitral valve replacement using beating heart technique improve postoperative LV function and clinical outcomes in patients with chronic severe mitral regurgitation and left ventricular dysfunction?
p-value: p=0.007
Beating heart mitral valve replacement is safe and preserves early postoperative left ventricular function better than warm blood cardioplegic arrest in patients with severe mitral regurgitation and LV dysfunction.
Beating-heart MVR may shorten ventilation/ICU stay and preserve early LV function in severe MR with dysfunction; extends limited RCT data on myocardial protection.
As a natural extension of warm heart surgery, beating heart valve surgery was born. The fundamental question was posed: why arrest the heart if technically adequate valve procedures could be accomplished with continuous warm perfusion? So this study was carried out to evaluate the results of mitral valve replacement on beating heart in patients with chronic severe mitral regurgitation and left ventricular dysfunction. Sixty patients underwent surgical correction of mitral insufficiency were prospectively randomized to 30 patients (group 1) mitral valve replacement using warm blood cardioplegia, and 30 patients (group II) mitral valve replacement using beating heart technique. Preoperatively, there was no significant difference between the two examined groups in age, sex, NYHA and echocardiographic data. The mitral surgical time (from beginning of opening of the left atrium till finishing left atrial closure) was significantly longer in the beating (group II) compared to the control (group I). However, the total bypass time was not significantly longer in the beating (group II) compared to the control (group I). The beating (group II) patients had shorter ventilation time and ICU stays time than in the control (group I). P value (0.003 and 0.049 respectively). Also (group II) patients had less incidence of low cardiac output status after surgery than the control (group I) (p value 0.007). The postoperative echocardiographic results showed a significant difference on LV myocardial function in favor of the beating technique (group II) over the cardioplegic technique (group I). Beating heart mitral valve replacement has proven in our study to be associated with better LV function early postoperatively than mitral valve replacement using warm bloody cardioplegic arrest. This together with the absence of related perioperative mortality and the major complications suggests that it is safe and beneficial to LV function.
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Elsherif et al. (2018) conducted an RCT in chronic severe mitral regurgitation and left ventricular dysfunction (n=60). Mitral valve replacement using beating heart technique vs. Mitral valve replacement using warm blood cardioplegia was evaluated on incidence of low cardiac output status after surgery (p=0.007). Mitral valve replacement using a beating heart technique reduced the incidence of low cardiac output status (P=0.007) and improved early postoperative LV function compared to warm cardioplegia.
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