Beating heart valve surgery with lung perfusion/ventilation during cardiopulmonary bypass: do we need to break the limits?

Abstract

Myocardial and pulmonary ischemia during cardiopulmonary bypass is associated with cardiac and pulmonary dysfunction that may result in poor outcomes after cardiac surgery. Beating heart valve surgery, utilizing continuous coronary perfusion with warm oxygenated blood, together with continuous pulmonary artery perfusion and alveolar ventilation during cardiopulmonary bypass, represents an emerging and exciting novel strategy for myocardial and pulmonary protection. In this article, we present preliminary clinical results, as well as basic and clinical evidence, indications, contraindications and limitations of these new evolving techniques.

Factors Associated with Safe Extubation in the Operating Room After On-Pump Cardiac Valve Surgery

“…The decision to use this technique was exclusively surgeon's. The technical details of pulmonary perfusion and ventilation during CPB are outside the scope of this report and are summarized elsewhere . During the study period, it included perfusion of pulmonary artery via three millimeter cannula connected to the port of the aortic cannula, and pulmonary ventilation with low tidal volumes (usually 3–5 mL/kg, 4–5 breaths/min), guided by continuous capnography.…”

Myocardial Protection Era: From Valve Surgery to Heart Transplantation

“…However, postoperative pulmonary dysfunction, respiratory failure, prolonged intensive care unit stay, and increased mortality, especially in patients with limited pulmonary functional reserve, are the consequences of poor lung protection during CPB. Cessation of perfusion/ventilation to alveoli leads to pulmonary endothelial damage (ischemia‐reperfusion injury), increased vascular permeability, edema, and hypoxia . We recently introduced a strategy for pulmonary protection during CPB based on maintenance pulmonary function—ventilation and perfusion.…”

“…We recently introduced a strategy for pulmonary protection during CPB based on maintenance pulmonary function—ventilation and perfusion. Discussed in detail elsewhere , the technique consists of a side catheter derived from the ascending aortic cannula inserted into the main pulmonary artery with continuous perfusion and ventilation with 50% air–oxygen mixture at tidal volumes of 4 mL/kg of ideal body weight, frequency of six breaths per minute, and positive end‐expiratory pressure of 5 cm H 2 O. Outcomes of a clinical trial will be forthcoming; however, preliminary data demonstrate improved postoperative pulmonary function and early extubation times, with considerable number of patients being extubated in the operation suite.…”