MITRAL VALVE REPLACEMENT ON BEATING HEART ; SAFETY-------- AN EVALUATION

Introduction: Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. The primary aim of this study was to evaluate and compare safety of Mitral valve replacement on beating heart without using cross clamp with the conventional Mitral valve replacement. Material and methods: It was a retrospective observational study for study duration from 2012-2014. A total of 50 patients were randomly selected and were divided in 2 groups, 25 patients in each group. This study was conducted at the Department of Cardiovascular Surgery of Choudhry Pervaiz Elahi Institute of Cardiology, Multan. We divided the patients in two groups. All operations were carried out by team led by a consultant surgeon in our institution. Results: Our patients had the age range from 12 to 65 years (Mean ages=32.5 years ± 13.9000) the mostly this study included males 60 %. The study included Group A and Group B (beating heart versus conventional heart surgery) both groups contained randomized controlled patients with purposeful sampling. Minimum operative time 100 minutes or maximum operative time 160 minutes (Mean 195± 95.75) The P value remained non significant that P <0.001. The CPB time was 22 to 388 minutes (104.8 ± 97.4. Cross Clamp time, ICU stay intubation time, drainage, inotrope remained almost same in both groups. With P <0.001 Outcome variables of the patients. Discussion: The hazards of cardiopulmonary bypass and Cardioplegia are well known. Various studies have demonstrated decreased accumulation of extra cellular fluid, diminished lactate production and greater preservation of high energy stores when a strategy of myocardial protection simultaneous antegrade/ retrograde continous normothermic, normokalemic blood perfusion was used. These findings were the basis for using beating heart technique for mitral valve replacement, Aortic cross-clamping, Cardioplegia, and reperfusion injury leads to myocardial ischemia and is a critical issue in mitral valve surgery despite novel approaches to myocardial protection. Myocardial edema induced by the lack of myocardial contractions and impaired lymphatic flow due to Cardioplegia in the heart remaining in diastole is another cause of myocardial dysfunction. Conclusions: Outcomes obtained using this strategy of myocardial protection seem to compare favorably to those of historical series in which conventional myocardial protection with cardioplegic arrest were used.