Clinical and ultramicroscopic myocardial randomized study of beating versus arrested heart for mitral surgery.

نویسندگان

  • Clotario Neptali Carrasco Cueva
  • Maiara dos Santos Rocha
  • Carlos Maurício Cardeal Mendes
  • Luiz Antonio Rodrigues de Freitas
  • José Augusto Baucia
  • Roberto Badaró
چکیده

INTRODUCTION Beating heart surgery on normothermic bypass simulates physiologic cardiac status. OBJECTIVES This study compared clinical and transmission electron microscopic aspects of myocardial protection during mitral valve replacement using warm retrograde perfusion in empty beating versus arrested heart with cold blood anterograde cardioplegia. METHODS Randomized study to evaluate myocardial cellular ischemia-reperfusion of both techniques to replace the mitral valve. Thirty-four patients were randomly assigned into group A (beating heart) and group B (arrested heart). The following parameters were assessed: echocardiography, blood chemistry, hemoglobin, lactate. During the surgical procedure a total of 102 myocardial biopsies were performed for ultrastructural analysis from anterior left ventricular wall: before cardiopulmonary bypass, before aortic desclamping and 10 minutes after reperfusion. RESULTS Elevation of lactate at 3 hours during the procedure was higher in group A, but similar at the end of surgery (P=0.06). Cardioversion was necessary in 5/17 (A) vs. 13/17 (B) P=0.07. Median intraoperative systemic temperature was significantly lower in the group B compared to A (32° C vs. 36° C), P<0.001. There was no significant difference of the ultramicroscopic aspects of the heart biopsies before, during and after surgery in both groups. Cellular and mitochondrial transient abnormalities such as mitochondrial swelling, glycogen loss and cytosol swelling were detected independently of the moment of the biopsies. CONCLUSION Myocardial protection and ultrastructural abnormalities were similar for both types of mitral valve replacement beating or arrested heart techniques.

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Efficacy and Safety of Beating Heart Mitral Valve Replacement

BACKGROUND The interest in beating heart surgery is growing since better results can be obtained with this procedure compared to conventional myocardial protection techniques using cardioplegic solutions. This led us to consider mitral valve replacement with beating heart. OBJECTIVES This study aimed to determine the safety and efficacy of beating heart mitral valve replacement without cross ...

متن کامل

Use of Carbon dioxide versus air blower in on-pump beating-heart coronary artery bypass surgery

Introduction:  The use of carbon dioxide blower has been recognized as the standard of care in patients undergoing beating coronary artery bypass grafting (CABG) due to higher solubility and lower risk of embolization. On the other hand, the compressed air blower has gone out of use since air can be easily trapped and is less soluble which can cause coronary embolism. The prese...

متن کامل

A comparison of beating heart and arrested heart techniques for mitral valve replacement surgery.

Introduction There is growing interest in beating heart cardiac surgery (mainly myocardial revascularization) without aortic cross-clamping and, if possible, without the use of a cardiopulmonary bypass (CPB) pump, since better results can be obtained with this procedure than with conventional myocardial protection techniques using cardioplegic solutions. This led us to considerer mitral valve r...

متن کامل

On-Pump Beating Coronary Artery Bypass in High Risk Coronary Patients

Background: There are some conflicting results with Conventional Coronary Artery Bypass Grafts (CCABG) with arrested heart in coronary high-risk patients. Moreover, performing off-pump CABG in these cases may be associated with serious complications. The objective of this study is to evaluate the efficacy of the on-pump beating CABG (OPBCABG) in coronary high-risk patients in comparison with th...

متن کامل

Mitral Valve Replacement On

Introduction: Cardiac reperfusion injury is a well-described complication occurring after ischemia or following cardioplegic arrest. The primary aim of this study was to evaluate and compare safety of Mitral valve replacement on beating heart without using cross clamp with the conventional Mitral valve replacement. Material and methods: It was a retrospective observational study for study durat...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

برای دانلود متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

عنوان ژورنال:
  • Revista brasileira de cirurgia cardiovascular : orgao oficial da Sociedade Brasileira de Cirurgia Cardiovascular

دوره 28 2  شماره 

صفحات  -

تاریخ انتشار 2013