Beating-heart versus conventional mitral valve replacement; a randomized clinical trial

Abd-Allah Badr; Essam  Yousef; Mostafa Kotb; Ahmed Deebis

doi:10.35810/ects.v1i1.137

Abd-Allah Badr Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Sharqeya, Egypt
Essam Yousef Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Sharqeya, Egypt
Mostafa Kotb Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Sharqeya, Egypt
Ahmed Deebis Cardiothoracic Surgery Department, Faculty of Medicine, Zagazig University, Sharqeya, Egypt

DOI: https://doi.org/10.35810/ects.v1i1.137

Keywords: Beating heart, Cardioplegic arrest, Mitral valve replacement

Abstract

Background: Various methods have been developed to overcome the deleterious effects of ischemia/ reperfusion injury that occurs after cardioplegic arrest. The aim of the study was to assess the safety, efficacy, and applicability of the beating-heart mitral valve replacement (MVR) compared to the conventional MVR.

Methods: Forty patients scheduled for mitral valve replacement were randomly assigned into two groups, conventional MVR as the control group (n= 20) and beating-heart MVR with continuous antegrade coronary perfusion as the study group (n=20). Three patients in the beating-heart group were converted to the conventional technique because of the blood-flooded field and excluded from the analysis.

Results: The preoperative clinical and echocardiographic variables were comparable between both groups. There was no significant difference between both groups regarding cardiopulmonary bypass time (79.4± 14 vs. 75.7± 10.9 minutes; p= 0.398) and total operative time (200± 55.6 vs. 183.9± 67.5 min; p= 0.458) in the conventional and beating-heart group, respectively. Serum troponin I level was significantly higher in the conventional MVR group 6 hours postoperatively (4.9±4 vs. 2.7±1.2 ng/ml; p= 0.036), while there was no significant difference between both groups regarding total CK and CK-MB (p= 0.565 & 0.597 respectively). Eight patients (44%) in the conventional MVR group needed inotropic support compared to 3 patients (19%) in the beating-heart MVR group (P = 0.11). There was no operative mortality or major morbidity in both groups. At 6-months follow-up, there was no difference in NYHA class (1.3±0.3 vs. 1.2±0.3; p= 0.336) and the ejection fraction (60.0±6.3 vs. 63.2±6 %; p= 0.139) in the conventional vs. beating-heart group.

Conclusion: Beating-heart MVR is a safe alternative to the conventional method with comparable outcomes. There is a relatively blood-filled field compared to the conventional technique.