Lung perfusion and ventilation during implantation of left ventricular assist device as a strategy to avoid postoperative pulmonary complications and right ventricular failure

Right ventricular failure is a major contributor to increased morbidity and mortality in patients undergoing left ventricular assist device implantation. Cardiopulmonary bypass is associated with increased pulmonary ischaemia and pulmonary vascular resistance. Continuous pulmonary perfusion and ventilation represents an emerging strategy for pulmonary protection during cardiac surgery. We hypothesize that this technique may have a pivotal role in reducing postoperative right ventricular dysfunction in high-risk patients undergoing LVAD placement.

Mitral valve replacements under on-pump beating heart and lung perfusion/ventilation using a minithoracotomy: an experience with 11 cases

BACKGROUND

The primary aims of minimally-invasive cardiac valve surgery are to lessen the impact of the incision, extracorporeal circulation, myocardial ischemia, and pulmonary ischemia, to obtain satisfactory therapeutic results, and to allow a quicker rehabilitation. In this study, the feasibility of minimally-invasive mitral valve replacements without ascending aorta and vena cava cross-clamping under beating heart was evaluated by surveying 11 patients.

METHODS

Preoperative risk factors, intraoperative techniques, and postoperative complications were surveyed and evaluated for one year (April 1, 2009 to March 30, 2010) in 11 patients who had undergone beating-heart mitral valve replacement surgery at The People's Hospital of Guangxi Zhuang Autonomous Region. Minithoracotomy and femoral arterial cannulation procedures were used in the surgeries for cardiopulmonary bypass (CPB) without ascending aorta and vena cava cross-clamping.

RESULTS

The operations were performed successfully in all 11 patients. The CPB time was 52.80 ± 11.36 minutes; the mean postoperative mechanical ventilation assistance time was 8.20 ± 2.84 hours; and the mean transfusion volume of red cells was 2.20 ± 1.04 units. There were no cerebral complications, no periprosthetic leakage, no occurrence of permanent high-degree atrioventricular blockage, and no mortality.

CONCLUSION

Mitral valve replacement on the beating heart using a minithoracotomy and femoral arterial cannulation for CPB without ascending aorta and vena cava crossclamping under pulmonary ventilation is feasible. A larger number of patients are required to further characterize the efficacy and safety of this procedure.