Replacement of the ascending aorta and aortic valve on beating heart

Objective: to explore the possibilities and advantages of performing aortic and aortic valve surgery on a beating heart compared to the traditional method involving cardiopulmonary bypass and cardioplegia.

Materials and methods: the experience of prosthetic replacement of the ascending aorta and aortic valve on a beating heart is presented, which allows avoiding circulatory arrest and the use of cardioplegia.

Results: positive clinical experience indicates that surgery on a beating heart promotes physiological myocardial contraction and continuous perfusion, thereby reducing myocardial injury compared to conventional techniques.

Conclusions: traditional surgery with cardioplegic arrest is associated with «mandatory ischemia», which disrupts electrolyte and oxygen balance in the myocardium and can lead to metabolic and structural damage. Consequently, there is a growing practice of performing surgeries on a beating heart using continuous retrograde coronary perfusion (CRCP), which helps reduce ischemia duration, lower complication risks, and improve procedural safety. The paper presents clinical cases of successful operations using this method, as well as comparative studies demonstrating the advantages of CRCP over traditional cardioplegia: shorter operation times, reduced postoperative mortality and complications, and more precise assessment of pathology under physiological conditions. Notably, the method shows particular effectiveness in correcting sinus of Valsalva ruptures and in surgeries involving the aortic root and valves. Overall, beating-heart surgery represents a promising approach to enhancing the safety and efficacy of cardiac surgical procedures.

1. Weman S.M., Karhunen P.J., Penttila A., et al. Reperfusion injury associated with one-fourth of deaths after coronary artery bypass grafting. Ann Thorac Surg. 2000; 70 (3): 807-12. DOI: 10.1016/s0003-4975(00)01638-6

2. Cicekcioglu F., Parlar A.I., Altinay L., et al. Beating heart mitral valve replacement in a patient with a previous Bentall operation. Gen Thorac Cardiovasc Surg. 2008; 56: 226–228. DOI: 10.1007/s11748-007-0225-4

3. Skopin I.I., Ismagilova S.A. Simultaneous plastic surgery of the mitral and tricuspid valves on a beating heart through right-sided anterolateral thoracotomy after previously performed heart surgery. Pathology of blood circulation and cardiac surgery. 2015; 19 (1): 101-103. DOI: 10.21688/1681-3472-2015-1-101-103 [In Russ].

4. Skopin I.I., Vavilov A.V., Merzlyakov V.Yu., et al. Mitral valve replacement on a beating heart in combination with minimally invasive myocardial revascularization in a patient with acute ischemic mitral insufficiency type II. Cardiology and cardiovascular surgery. 2019; 12 (1): 60 63. DOI: 10.17116/kardio20191201160 [In Russ].

5. Pichugin V.V., Medvedev A.P., Gamzaev A.B., et al. Valve replacement surgery in conditions of a ≪beating heart≫ as an alternative to the use of cardioplegia in patients with low myocardial reserve. Medical almanac. 2008; special issue: 136-141 [In Russ].

6. Babaroglu S., Yay K., Parlar A.I., et al. Beating heart versus conventional mitral valve surgery. Interact Cardiovasc Thorac Surg. 2011; 12 (3): 441-7. DOI: 10.1510/icvts.2010.255240

7. Salerno T.A., Panos A.L., Tian G., et al. Surgery for cardiac valves and aortic root without cardioplegic arrest (≪beating heart≫): experience with a new method of myocardial perfusion. J Card Surg. 2007; 22 (6): 459-64. DOI: 10.1111/j.1540-8191.2007.00448.x

8. Mo A., Lin H. Surgical correction of ruptured aneurysms of the sinus of Valsalva using on-pump beating-heart technique. J Cardiothorac Surg. 2010; 37 (5).1-4. DOI: 10.1186/1749-8090-5-37