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by Gianni Angelini, M.D.
Beating Heart Valve Surgery: Back to the Past or Back to the Future?
When Dr. Salerno first mentioned to me the concept of simultaneous antegrade/retrograde normothermic blood perfusion during valve surgery, I had a sense of déjà vu back to my early years as a trainee in cardiac surgery when continuous perfusion was used prior to the establishment of the modern technique of cardioplegic myocardial protection. The memory of those experiences, with cannulae coming out of the coronary ostiae and low cardiac output status following the surgery, did not endear me towards Dr. Salerno’s technique, which at first sounded like a re-hashing of the past.
However, the more I spoke to, and saw Dr. Salerno’s results, the more I realised that this was something altogether different. The simultaneous antegrade and retrograde was perhaps the most innovative aspect of this continuous perfusion. As Dr. Salerno points out in his article, some of this concept has been the direct consequence of the development of beating heart coronary revascularisation, where the idea is to prevent any form of ischaemia. After all, it doesn’t matter how protective the cardioplegic solution is, there is always some ischaemic reperfusion damage. The technique described here by Dr. Salerno and his associates is intriguing. Undoubtedly it has a lot of technical aspects which need careful evaluation if anybody decided to embark into adopting it, and perhaps some refinements in order to make it easier to use by the average cardiac surgeon.
A lot of people were sceptical when beating heart coronary revascularisation was introduced. Some remain sceptical, so I wouldn’t expect a much different attitude with regard to beating heart valve surgery. So, let us know what you think about this – are we going back to the past or back to the future?
Guest Commentaries
Dr. Tomas Salerno: Simultanous Antegrade/Retrograde Normothermic Blood Perfusion of the Heart in Valvular and Other Complex Surgery (Beating Heart Valvular Surgery): A New Concept in Myocardial Protection
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