Clampless Beating Heart Mitral Valve Replacement in Dilated Cardiomyopathy

A. Boukhmis, Mohammed El-Amin Nouar, K. Khacha, Yacine Djouaher
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Abstract

Patients with secondary mitral regurgitation (SMR), the majority of which is ischemic, often have atherosclerotic ascending aorta and left ventricular (LV) dysfunction. In these patients, restrictive mitral annuloplasty is associated with a high rate of MR recurrence, aortic cross-clamping increases the stroke rate, and cardioplegic arrest increases postoperative low cardiac output syndrome. To avoid these complications, beating heart mitral valve replacement without aortic cross-clamping has been proposed. Here, we describe two male patients, aged 71 and 54 years, with severe SMR and low left ventricle ejection fraction (LVEF) (24% and 30%, respectively). Beating-heart mitral valve replacement with total chordal sparing was performed without aortic cross-clamping through a full sternotomy. Weaning from cardiopulmonary bypass was easily achieved without use of inotropes. The duration of mechanical ventilation (3 and 6 hours, respectively) and intensive care (24 and 48 hours, respectively) was short. Neither patients presented with postoperative neurological disorders. After a mean follow-up of 66 months, both patients were asymptomatic, without prosthetic valve dysfunction, and their LVEF reached 42% and 51%, respectively. This cases study indicates that for patients with SMR with impaired LV function who are at high risk for cardioplegic arrest, clampless beating heart mitral valve replacement with total preservation of the subvalvular apparatus could reduce stroke incidence, preserve peri-operative LVEF, and allow reverse LV remodeling.
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扩张型心肌病无夹钳搏动心脏二尖瓣置换术
继发性二尖瓣反流(SMR)患者,其中大多数是缺血性的,通常有动脉粥样硬化性升主动脉和左心室功能障碍。在这些患者中,限制性二尖瓣成形术与MR复发率高相关,主动脉交叉夹紧增加卒中发生率,心脏骤停增加术后低心输出量综合征。为了避免这些并发症,已经提出了不经主动脉交叉夹紧的心脏搏动二尖瓣置换术。在这里,我们描述了两名男性患者,年龄分别为71岁和54岁,患有严重的SMR和低左心室射血分数(LVEF)(分别为24%和30%)。心脏搏动二尖瓣置换术,保留全部脊索,不经胸骨切开主动脉交叉夹紧。在不使用肌力药物的情况下,很容易实现体外循环的脱机。机械通气时间(分别为3、6小时)和重症监护时间(分别为24、48小时)较短。两例患者均未出现术后神经系统疾病。平均随访66个月后,两例患者无症状,无人工瓣膜功能障碍,LVEF分别达到42%和51%。本病例研究表明,对于伴有左室功能受损的SMR患者,其心脏骤停风险较高,无夹搏动心脏二尖瓣置换术可降低卒中发生率,保留瓣下器官,并可实现左室的逆转重构。
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