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. 2020 Apr;84(2):159-162.

Pilot study investigating the feasibility of mitral valve repair without aortic cross-clamping and cardioplegia

Wanda J Gordon-Evans  1 , John P Carney  1 , Mathew T Lahti  1 , Richard W Bianco  1
Affiliations

Pilot study investigating the feasibility of mitral valve repair without aortic cross-clamping and cardioplegia

Wanda J Gordon-Evans et al. Can J Vet Res. 2020 Apr.

Abstract
in English, French

There is evidence that perfusing the heart with a heart and lung machine is less injurious than cross-clamping the aorta and administering cardioplegia during cardiac surgery. Although mitral valve replacement has been carried out without aortic cross-clamping and cardioplegia, it has been stated that cross-clamping is necessary in order to maintain visualization and a motionless surgical field for mitral valve repair. The purpose of this study was to determine the surgical feasibility of mitral valve repair without cross-clamping the aorta and using cardioplegia. Our hypothesis was that a completely bloodless and motion-free field would not be necessary to carry out mitral valve repair with annuloplasty and synthetic chordae tendineae sutures. Papillary muscles, chordae tendineae, annulus, and mitral valve leaflets were all readily visualized. Chordae tendineae sutures were used and annuloplasty was conducted without visual obstruction or motion interference. Our results show that mitral valve repair is feasible without cross-clamping the aorta and using cardioplegia.

Des évidences existent que la perfusion du coeur avec une machine coeur-poumon artificielle est moins dommageable que le clampage de l’aorte et une cardioplégie lors de chirurgie cardiaque. Bien que le remplacement de valvules mitrales ait été réalisé sans clampage de l’aorte et cardioplégie, il a été mentionné que le clampage est nécessaire afin de maintenir une visualisation et un champ chirurgical sans mouvement pour la réparation de valvule mitrale. Le but de la présente étude était de déterminer la faisabilité chirurgicale de réparation de la valvule mitrale sans clampage de l’aorte et en utilisant la cardioplégie. Notre hypothèse était qu’un champ avec absence complète de sang et sans mouvement ne serait pas nécessaire pour effectuer une réparation de la valvule mitrale avec annuloplastie et sutures avec des cordages tendineux synthétiques. Les muscles papillaires, les cordages tendineux, l’annulus, et les feuillets de la valve mitrale étaient tous facilement visualisables. La suture des cordons tendineux fut utilisée et l’annuloplastie menée sans aucune obstruction visuelle ou interférence par les mouvements. Nos résultats suggèrent que la réparation des valvules mitrales est faisable sans clampage de l’aorte et sans cardioplagie.(Traduit par Docteur Serge Messier).

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Figures

Figure 1
Figure 1
Intraoperative view of the heart without aortic cross-clamping and cardioplegia. Annulus and chordae tendineae are clearly visible. The left atrium is retracted using a Cooley retractor. Dorsal is at the top of the picture and ventral at the bottom.
See this image and copyright information in PMC

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