Document Detail


Beating-heart mitral valve surgery in patients with poor left ventricular function.
MedLine Citation:
PMID:  15311869     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND AND AIM OF THE STUDY: Mitral valve surgery in the presence of poor left ventricular (LV) function is associated with higher mortality. One surgeon's (S. K. N.) evolving practice of mitral valve surgery on the beating heart using normothermic cardiopulmonary bypass (CPB) in a cohort of patients is described. METHODS: Between July 2000 and December 2002, 23 patients (13 men, 10 women; mean age 68.6 +/- 4.8 years; range: 54-81 years) with mitral regurgitation and LV ejection fraction <30% undergoing isolated mitral valve repair (n = 4) or replacement (n = 19) were investigated. All patients received maximal drug therapy. Among patients, 17 were in NYHA class III, and six in class IV. RESULTS: The mean duration of follow up was 17 +/- 14 months, and was complete for all survivors. The visual field of the on-pump beating heart was equal to that of conventional valvular surgery, and technical accuracy was not compromised. The mean ICU and hospital stays were 2.4 +/- 1.3 days and 8.9 +/- 2.6 days, respectively. Mean CPB time was 74.3 +/- 14.8 min. Thirty-day mortality was significantly lower (8.7%) when compared to mean Euroscore-predicted mortality for this high-risk group (16.9%; p <0.001). The medium-term one- and two-year survivals were 87% and 78%, respectively. Mean NYHA class was improved, from 3.6 +/- 0.5 preoperatively to 1.9 +/- 0.7 at follow up (p = 0.037). CONCLUSION: On-pump, beating-heart mitral valve surgery is a good option in patients with poor LV function, and is advantageous as conditions for the heart are more physiological with a beating tonus than with cardioplegia.
Authors:
Sudip Ghosh; Rajwinder S Jutley; Philip Wraighte; Matloubb Shajar; Surendra K Naik
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Journal of heart valve disease     Volume:  13     ISSN:  0966-8519     ISO Abbreviation:  J. Heart Valve Dis.     Publication Date:  2004 Jul 
Date Detail:
Created Date:  2004-08-17     Completed Date:  2004-11-06     Revised Date:  2006-05-04    
Medline Journal Info:
Nlm Unique ID:  9312096     Medline TA:  J Heart Valve Dis     Country:  England    
Other Details:
Languages:  eng     Pagination:  622-7; discussion 627-9     Citation Subset:  IM    
Affiliation:
Department of Cardiothoracic Surgery, Northern General Hospital, Sheffield, UK. sudip.ghosh@talk21.com
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Cardiopulmonary Bypass
Combined Modality Therapy
Coronary Artery Bypass
Female
Follow-Up Studies
Great Britain
Heart Valve Prosthesis Implantation*
Humans
Length of Stay
Male
Middle Aged
Mitral Valve / physiopathology,  surgery*
Mitral Valve Insufficiency / mortality,  physiopathology,  surgery*
Postoperative Complications / etiology,  mortality,  physiopathology
Stroke Volume / physiology
Survival Analysis
Time Factors
Treatment Outcome
Ventricular Dysfunction, Left / mortality,  physiopathology,  surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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