ABSTRACT 40

Aortic and Mitral Valve Surgery on the Beating Heart

Borut Gersak, MD, PhD, Department of Cardiovascular Surgery, University Medical Center, Ljubljana, Slovenia

Background: Off-pump CABG has led us to consider the possibility to perform the aortic and mitral valve replacements / repairs - with or without CABG on the beating heart with the retrograde oxygenated coronary sinus perfusion.

Methods:We used this technique in 35 patients with extremely low ejection fractions, 96% of them were in NYHA class 4 and 3. The procedures were: aortic valve (and CABG) – 6 patients, double and tripple valves – 13 patients, mitral and tricuspid – 11 patients, double valves (and CABG) – 4 patients, mitral valve (and CABG) – 1 patient.

Results:Mean cardiopulmonary bypass time was 92,34 minutes, mean aortic crossclamp time was 63,45 minutes and the mean flow through the coronary sinus was 422 ml/minute. The total mortality was 8%. None of these deaths were cardiac related (CVI, prostetic valve endocarditis, systemic infection).

Conclusions:The procedure could be the procedure of choice for the valve operation or combined operations (valve aopreation and CABG) in high-risk patients with low ejection fractions. Perhaps the beating heart valve operations are the beginning of the procedures without cardiopulmonary bypass.