TY - JOUR
T1 - Aortic root replacement in severe left ventricular dysfunction
T2 - The added value of beating-heart surgery
AU - Ganizada, Berta
AU - Heuts, Samuel
AU - Willems, Colin
AU - Cortenraad, Inez
AU - Tunnissen, Willemijn
AU - Maessen, Jos G
AU - Bidar, Elham
AU - Natour, Ehsan
N1 - © 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC.
PY - 2022/11
Y1 - 2022/11
N2 - There are limits to the use of cardioplegic arrest during complex cardiac surgical procedures, especially in patients with severe left ventricular dysfunction. In the current report, we graphically present the detailed surgical strategy and technique for beating-heart aortic root replacement with concomitant coronary bypass grafting, for patients otherwise deemed inoperable. With support of cardiopulmonary bypass (CPB), beating-heart bypass surgery is realized, after which the bypass grafts can selectively be connected to the CPB, preserving coronary flow. Then, on the beating and perfused heart, a complex procedure such as aortic root replacement can be performed, without jeopardizing postoperative cardiac function. However, several important caveats and remarks regarding the use of beating-heart surgery should be considered, including: coronary perfusion verification and maintenance, temperature management, and prevention of air embolisms. By use of this strategy, risks associated with cardioplegic arrest are minimized, while it circumvents the potential need for long-term postoperative extracorporeal membrane oxygenation.
AB - There are limits to the use of cardioplegic arrest during complex cardiac surgical procedures, especially in patients with severe left ventricular dysfunction. In the current report, we graphically present the detailed surgical strategy and technique for beating-heart aortic root replacement with concomitant coronary bypass grafting, for patients otherwise deemed inoperable. With support of cardiopulmonary bypass (CPB), beating-heart bypass surgery is realized, after which the bypass grafts can selectively be connected to the CPB, preserving coronary flow. Then, on the beating and perfused heart, a complex procedure such as aortic root replacement can be performed, without jeopardizing postoperative cardiac function. However, several important caveats and remarks regarding the use of beating-heart surgery should be considered, including: coronary perfusion verification and maintenance, temperature management, and prevention of air embolisms. By use of this strategy, risks associated with cardioplegic arrest are minimized, while it circumvents the potential need for long-term postoperative extracorporeal membrane oxygenation.
U2 - 10.1111/jocs.16879
DO - 10.1111/jocs.16879
M3 - Article
C2 - 36047388
SN - 0886-0440
VL - 37
SP - 3984
EP - 3987
JO - Journal of Cardiac Surgery
JF - Journal of Cardiac Surgery
IS - 11
ER -