307 On-Pump Beating Heart Mitral Valve Surgery without Cross-Clamping the Aorta Salih Fehmi Katircioglu, M.D., Ferit Cicekcioglu, M.D., Ufuk Tutun, M.D., Ali Ihsan Parlar, M.D., Seyhan Babaroglu, M.D., Ufuk Mungan, M.D., and Aysen Aksoyek, M.D. Cardiovascular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, Ankara, Turkey ABSTRACT Background and Aim: Cardiac reperfusion injury is a well-described complication occurring af- ter ischemia or following cardioplegic arrest. Various strategies have been developed to prevent ischemic reperfusion injury. The aim of this study was to assess the efficacy and applicability of the on-pump beat- ing heart mitral valve surgery without cross-clamping the aorta in order to prevent reperfusion injury. Methods: The prospective study (between April 2005 and December 2006) included 88 consecutive patients who underwent mitral valve surgery. The operations were carried out on a beating heart using normother- mic cardiopulmonary bypass without cross-clamping the aorta, therefore perfusing the heart antegradely through the aortic root. Venting the heart from the aorta and the pulmonary vein provided adequate visual- ization of the operative field. Results: Seventy-eight patients (88.6%) underwent mitral valve replacement and 10 patients (11.3%) underwent mitral valve repair with this technique. Concomitant surgery was re- quired in 29 patients (32.9%). Twenty-five patients (28.4%) had also undergone previous open heart surgery. Mean cardiopulmonary bypass time was 57.4 ± 18.4 minutes. Mean duration of ventilation was 12.2 ± 3.5 hours, mean intensive care unit stay was 1.3 ± 1.6 days, and mean hospital stay was 6.9 ± 4.5 days. One-year survival was 96.6% for all causes of mortality. Conclusions: In this study, we showed that on- pump beating heart operations without cross-clamping is an acceptable surgical choice for mitral valve disease. Complication rates are low and perioperative mortality is lower than that generally reported with conventional technique. doi: 10.1111/j.1540-8191.2008.00648.x (J Card Surg 2008;23:307-311) Mitral valve operations are usually performed under cardioplegic arrest with cross-clamping the aorta. Ef- ficacy and safety of operations with cardioplegic ar- rest have been well established. However, ischemia and reperfusion injury still remain a phenomenon to be solved. In order to overcome deleterious affects of ischemia/reperfusion injury, various methods and solutions have been developed. 1-4 These affects can be more prominent in patients with impaired ven- tricular function and/or right ventricular hypertrophy. In these patient subgroups, lack of sufficient oxy- gen delivery to the myocardium during cross-clamping of the aorta between replenishments of the cardio- plegic solution may lead to low cardiac output syn- drome requiring high-dose inotropic drug support. 1-4 Keeping the heart beat, while providing nutritive blood supply throughout the procedure, is an option which was popularized in the late 1980s. Off-pump coro- nary artery bypass grafting (CABG) has gained popu- larity in the last two decades. Recently, use of beating This paper has been presented at the 9th National Congress of Turkish Society of Cardiovascular Surgery; Maritim Pine Beach Resort Hotel, Belek, Antalya/Turkey; November 01–05, 2006 Address for correspondence: Salih Fehmi Katircioglu, M.D., Cardiovas- cular Surgery Clinic, Turkiye Yuksek Ihtisas Hospital, 06100, Sihhiye, Ankara, Turkey. Fax: +90-312-229-58-68; e-mail: fehmiege@yahoo.com heart valve surgery technique with successful results has been published. 5-12 It seems reasonable using on- pump beating heart technique for heart valve surgery as long as myocardial perfusion is maintained and par- ticulate or air embolism is avoided. We assume that the most convenient way to protect the myocardium dur- ing cardiac surgery is to perfuse the heart with whole blood without cardioplegic arrest. We adopted a tech- nique for mitral valve surgery with normothermic car- diopulmonary bypass (CPB) without cross-clamping the proximal aorta while maintaining myocardial perfusion antegradely through the aortic root for myocardial pro- tection. Our targets were maintenance of normother- mic blood supply to the myocardium, while eliminat- ing undetected ischemia and reperfusion injury and avoidance of the side effects of hypothermia and aortic cross-clamping. 8,12-17 The aim of this study was to assess the efficacy and applicability of on-pump beating heart mitral valve surgery without using aortic cross-clamp and cardio- plegic arrest. MATERIAL AND METHODS Between April 2005 and December 2006, 88 consec- utive patients underwent beating mitral valve surgery