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VIDEO-ASSISTED BEATING HEART SURGERY IN HIGH RISK PATIENTS
Moritz Wyler von Ballmoos, Ghulam Murtaza, Saqib Masroor.
Medical College of Wisconsin, Milwaukee, WI, USA.
OBJECTIVE:
Warm perfused beating heart surgery affords excellent myocardial protection while minithoracotomy reduces trauma and bleeding. We present our experience combining mini-thoracotomy and beating heart surgery in high-risk patients requiring mitral valve, tricuspid valve or cryomaze (CRYO) surgery.
METHODS:
Between September 2006 and December 2010, 14 consecutive high-risk patients underwent video-assisted beating heart surgery via right mini-thoracotomy and peripheral cardiopulmonary bypass by a single surgeon. 4 emergent procedures included redo MVR/TVR, MVP/TVR (n=2) and MVR/TVR/CRYO (n=2). All were in cardiogenic shock, had PAS pressures > 75 mm Hg, hepatorenal failure and two were intubated. 5 urgent procedures included acute reoperation for redo MVR/CRY, MVR/TVR±CRYO (biventricular failure, PAS pressure > 75 mm Hg, n=2), CRYO (acute PE, recent hemorrhagic stroke, AF cardiomyopathy) and MVR (dilated CMP, EF=10%). 5 elective procedures included redo TVR±CRY (n=2) and CRYO (CMP, EF 10-30%, n=3).
RESULTS:
There was no conversion to sternotomy, re-exploration, stroke or new-onset renal failure. Intraoperative ventricular assistance or intraaortic balloon pump was not needed. 11/14 patients are alive at a mean of 24 months after surgery (Table 1). One patient each died of hepatorenal failure (27 days), cardiac failure (12 months, dilated CMP) and lung cancer (24 months).
CONCLUSIONS:
In this select group of high-risk patients minimally invasive beating heart surgery is associated with excellent results. Because it avoids ischemia-reperfusion, this approach is particularly beneficial for emergency operations and patients with right ventricular dysfunction and severe pulmonary hypertension.
| Mortality | ||||||
| Mean Age (y) | Mean Length of Stay (d) | CPB Time (min) | Operative | 30 Day | Follow Up | |
| Elective (n=5) | 60 (±17) | 4.8 (±1.9) | 132.8 (±43.4) | 0 | 0 | 1 |
| Urgent (n=5) | 61 (±25.7) | 7 (±1) | 121.1 (±35.4) | 0 | 0 | 1 |
| Emergent (n=4) | 60.8 (±19.3) | 23.5 (±12.8) | 181.3 (±47.6) | 0 | 1 | 0 |
| Group (n=14) | 60.5 | 10.9 | 142.5 | 0 | 1 | 2 |
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