Background Surgical repair of mitral valve disease and concomitant coronary artery occlusive disease has high operative risk. Myocardial protection for protracted, complicated procedures is seminal to the overall operative outcome; specifically, preservation of left ventricular function. Methods The authors conducted a retrospective review of 25 patients undergoing combined mitral valve repair/replacement (MVR) and coronary artery bypass surgery (CABG) using the beating-heart technique at the Miller/University of Miami School of Medicine. The CABG was performed without cardiopulmonary bypass support. During the mitral valve surgery the perfusion pressure was maintained at 80–90 mm Hg and the systemic temperature at 35–36°C. The aorta was not cross-clamped. Results Twenty-five patients underwent MVR/CABG, including 7 patients with acute myocardial infarction. Preoperative echocardiograms revealed a mean ejection fraction (EF) of 41 ± 4.5%. One patient required a preoperative intraarterial balloon pump. An average of 2.12 ± 0.9 grafts and a total of 10 mitral valve repairs were performed. The average length of stay in the intensive care unit was 14 ± 1.8 days, and average hospitalization time was 23 ± 3. The mean postoperative EF was 41 ± 4.5%. The mortality in this patient group was 12 % (3/25) with a morbidity rate of 52% (13/25). Conclusions The data suggest that the technique is safe and reproducible, and that it potentially has a short-term benefit on left ventricular function. Therefore, this particular technique may be efficacious in patients with compromised left ventricular function requiring a combined MVR/CABG.
7 Left ventricular function after mitral valve surgery for chronic mitral regurgitation
