Clampless Beating Heart Mitral Valve Replacement in Dilated Cardiomyopathy

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.