Beating heart mitral valve surgery: results in 120 consecutive patients considered non-suitable candidates for conventional mitral valve surgery
Stephan Jacobs, Simon Sündermann, Volkmar Falk.
German Heartcenter Berlin, Berlin, Germany.
OBJECTIVE: To assess whether beating heart mitral valve surgery is a valuable option in patients considered very high-risk candidates or inoperable for conventional mitral valve surgery.
METHODS: One-hundred twenty patients (mean age 63.7±12.1 years, range 25.3-88.8 years; mean logistic EuroSCORE 26.1±20.6%, range 1.5%-84.3%) undergoing beating heart mitral valve surgery using normothermic cardiopulmonary bypass (CPB) without aortic cross-clamping and without cardioplegia between September 2002 and April 2014 were included in this retrospective, single-center, observational cohort study . Pre-operatively, 14 (11.7%) patients were in cardiogenic shock, 16 (13%) were on ventilator, 33 (27.5%) received inotropic support, 12 (10%) had dialysis and one was on an extracorporal membrane oxygenator (ECMO). Sixty-five (54%) patients had at least one (range 1-6) previous heart operations. Mean follow-up was 920±973 days.
RESULTS: Isolated Mitral valve surgery was performed in 75 (62.5%) patients. Combined Mitral valve procedures were performed in 45 (37.5%) patients. Fifty-eight (49%) patients had emergency or urgent procedures and 62 (51%) were treated elective. Mean cardiopulmonary bypass time was 103±39 minutes (median 94 minutes, range 45-252, IQR 75-121.5 minutes). There were no conversions to conventional surgery. Overall 30-day mortality was 10% including patients in cardiogenic shock and 7.5% for patients without preoperative cardiogenic shock. Five (4.2%) patients had early re-thoracotomy for bleeding, three had (2.5%) disabling and two (1.7%) non-disabling stroke. Overall 6-month, 1-year, 2-year and 5-year survival were 73.0±4.2%, 63.5±4.6%, 56.5±4.8% and 37.4±5.0%, respectively (Figure 1). Multivariate analysis revealed age (HR 1.04, 95%CI 1.01-1.06, p=010) and creatinine (HR 1.53, 95%CI 1.23-1.91, p<0.001) to be relevant for late survival.
CONCLUSIONS: Patients considered non-suitable candidates for conventional mitral valve surgery had favourable post-operative course and survival if the operation was performed on the beating heart.
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