Aortic and mitral valve replacement with retrograde perfusion in the beating heart

Objective To estimate the value of aortic valves and combined mitral valve replacement with retrograde perfusion in beating hearts. Methods Continuous retrograde coronary sinus perfusion with beating hearts was used in 83 patients undergoing aortic valve or aortic valve combined wi th mitral valve replacement, without application of cardioplegia. After aor tic valve replacement, the retrograde perfusion was changed to antegrade pe rfusion for mitral valve replacement or correction of the other deformities (group A). Cold blood cardioplegia solution (15 degreesC) was infused at i ntervals in 20 cases (group B). The following parameters were tested: lacta te, ET, CTn-T and MDA in blood; myocardial ultra-structure; and cardiac rhy thm and cardiac output (CO). Results All biochemical values increased after cardiopulmonary bypass (P < 0.05 - 0.01) Empty and beating heart sinus rhythm was maintained in group A . Myocardial ultrastructure did not change significantly. The pump was stop ped smoothly as the surgical procedure finished. No postoperative low cardi ac output syndrome or arrhythmia was observed. Eight-one patients recovered smoothly, two died from renal failure or infective shock. When the pump st opped, all patients in group B were supported by 5 - 10 mug (.) kg(-1) (.) min(-1) dopamine. Transient pacing was used in 9 patients. One patient died from low cardiac output syndrome. Conclusion This method is a good myocardial protection which simulates phys iologic status. It is applicable to aortic valve and combined mitral valve replacement of patients with large heart or heart failure and long time aor tic cross-clamping. Ideal clinical effect can be achieved.