Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery

Objectives: The purpose of the study was to test whether a beating heart mitral valve operation was a valuable option in a heterogeneous group of patients considered very high risk for conventional mitral valve surgery.

Methods: We conducted a retrospective, single-centre, observational cohort study of 120 patients (mean age 63.7 ± 12.1 years, range 25.3-88.8 years; mean logistic EuroSCORE 26.1 ± 20.6%, range 1.5-84.3%) undergoing beating heart mitral valve operations using normothermic cardiopulmonary bypass without aortic cross-clamping and without cardioplegia between September 2002 and April 2014. Preoperatively, 14 (11.7%) patients were in cardiogenic shock, 16 (13%) on a ventilator, 33 (27.5%) receiving inotropic support, 12 (10%) on dialysis and 1 on extracorporeal membrane oxygenation. Sixty-five (54%) patients had had at least 1 (range 1-6) previous heart operation. The mean follow-up period was 920 ± 973 days.

Results: A mitral valve procedure was performed alone in 75 (62.5%) patients and combined with additional cardiac procedures in 45 (37.5%). Fifty-eight (49%) patients had emergency or urgent procedures and 62 (51%), elective procedures. The mean cardiopulmonary bypass time was 103 ± 39 min (median 94 min, range 45-252, interquartile range 75-121.5 min). There were no conversions to conventional procedures and no intraoperative deaths. The 30-day mortality rate for patients without cardiogenic shock was 7.5% (8 deaths among 106 patients). Among 14 (11.7%) patients who underwent an operation in cardiogenic shock, 4 died during the first 30 days (30-day mortality rate = 28.6%, Fisher's exact test P = 0.338 versus patients without shock). The lowest 30-day mortality rate was in patients operated on with the beating heart because of a porcelain aorta (n = 8 patients, 30-day mortality rate = 0%).

Conclusions: Patients considered unsuitable for a conventional mitral valve operation had favourable postoperative outcomes if the operation was performed on the beating heart.