Comparison Between Beating and Non–Beating-Heart Pump Approaches Among Patients Undergoing Pulmonary Valvar Surgery: A Randomized Clinical Trial

Document Type : Original Article

Authors

1 Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

2 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, IR Iran.

3 Taleghani Hospital, Shahid Beheshti University, Tehran, IR Iran.

4 Department of Epidemiology, Robert Stempel College of Public Health, Florida International University, Miami, FL, USA.

5 Department of Emergencies, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, IR Iran.

Abstract

Background: Open-heart surgery is usually done in 2 ways. The first and most common method is done with cardiac arrest after aortic clamping and the perfusion of the cardioplegic solution into the coronary arteries. The second method is the on-pump beating heart, done usually for the right-heart chambers. In this study, we sought to compare these 2 methods concerning cardiac muscle damage, kidney and liver parameters, and clinical outcomes in patients with isolated pulmonary valve repair.
 
Methods: Forty-three patients that underwent cardiopulmonary bypass were randomly assigned to 2 on-pump non-beating (n=20) and beating (n=23) heart groups. We assessed between-group hemodynamics and arterial blood gasses.
 
Results: The operation time was shorter in the beating-heart group than in the non-beating heart group (P=0.003). The ejection fraction (EF) at discharge in the non-beating group was significantly lower than that in the beating-heart group (44.25±6.12 vs 50.00±5.56). Cardiac troponin I and creatine phosphokinase levels showed significant decreases at the preoperative time in both groups; the levels were better in the beating-heart group. No changes were observed in arterial blood gasses before surgery, postoperatively, at intensive care unit admission, and 24 hours after surgery in the 2 groups. The potassium level after the operation was significantly lower in the beating-heart group (4.18 [± 0.85]).
 
Conclusions: The beating-heart surgical procedure conferred a better EF at discharge. Additionally, cardiac troponin I and creatine phosphokinase levels decreased after the preoperative time. (Iranian Heart Journal 2023; 24(1): 22-30)

Keywords

References

  1. Khan DT. Cardiovascular diseases (CVDs) 2017 [Available from: https://www.who.int/en/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds).
  2. Iranagh JA. Effectiveness of health education intervention based on health belief model among elderly women in urmia, iran. 2015.
  3. Tofield AJEHJ. Novel TAVI presented at South Africa Heart Congress 2016. 2017; 38(16):1181-2.
  4. Taegtmeyer H, Young ME, Lopaschuk GD, Abel ED, Brunengraber H, Darley-Usmar V, et al. Assessing cardiac metabolism: a scientific statement from the American Heart Association. Circulation research. 2016; 118(10):1659-701.
  5. Paal P, Gordon L, Strapazzon G, Maeder MB, Putzer G, Walpoth B, et al. Accidental hypothermia–an update. Scandinavian journal of trauma, resuscitation and emergency medicine. 2016; 24(1):1-20.
  6. Xia L, Ji Q, Song K, Shen J, Shi Y, Ma R, et al. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. 2017; 12(1):1-8.
  7. Godinho AS AA, Pereira AJ, Pereira TS. On-pump versus off-pump coronary-artery bypass surgery: a meta-analysis. Arq Bras Cardiol. 2016; 98:87–94.
  8. Lemma MG CE, Tritto FP, Centofanti P, Fondacone C, Salica A, et On-pump versus off-pump coronary artery bypass surgery in high-risk patients: operative results of a prospective randomized trial (on-off study). Thoracic Cardiovascular Surgery. 2012; 143:625–31.
  9. Darwazah AK BV, Isleem I, Helwa K. Myocardial revascularization using on-pump beating heart among patients with left ventricular dysfunction. J Cardiothorac Surg. 2016; 5:109.
  10. Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. European journal of heart failure. 2016; 18(3):226-41.
  11. Cappabianca G, Rotunno C, Schinosa LdLT, Ranieri VM, Paparella D. Protective effects of steroids in cardiac surgery: a meta-analysis of randomized double-blind trials. Journal of cardiothoracic and vascular anesthesia. 2011; 25(1):156-65.
  12. Badr A-A, Yousef E, Kotb M, Deebis A. Beating-heart versus conventional mitral valve replacement; a randomized clinical trial. The Egyptian Cardiothoracic Surgeon. 2020; 2(3):90-8.
  13. Walter KN, Wagner JA, Cengiz E, Tamborlane WV, Petry NM. The need for research addressing alcohol use disorder and diabetes. Addiction. 2015.
  14. Pasic M, Sündermann S, Unbehaun A, Kempfert J, Jacobs S, Falk V. Beating heart mitral valve surgery: results in 120 consecutive patients considered unsuitable for conventional mitral valve surgery. Interactive cardiovascular and thoracic surgery. 2017; 25(4):541-7.
  15. Harjola VP, Mebazaa A, Čelutkienė J, Bettex D, Bueno H, Chioncel O, et al. Contemporary management of acute right ventricular failure: a statement from the Heart Failure Association and the Working Group on Pulmonary Circulation and Right Ventricular Function of the European Society of Cardiology. heart failure. 2016; 18(3).
  16. XIAO Y-b, CHEN L, WANG X-f, ZHONG Q-j, CHEN J-j, CHENG B-c. On-Pump Beating-Heart Intracardiac Procedures in 2100 Cases [J]. Chinese Journal of Extracorporeal Circulation. 2006; 4.
  17. Matsumoto Y, Watanabe G, Endo M, Sasaki H, Kasashima F, Kosugi I. Efficacy and safety of on-pump beating heart surgery for valvular disease. The Annals of thoracic surgery. 2002; 74(3):678-83.
  18. Velioglu Y, Isik M. Early-Term Outcomes of Off-Pump versus On-Pump Beating-Heart Coronary Artery Bypass Surgery. The Thoracic and cardiovascular surgeon. 2019; 67(07):546-53.
  19. Rastan AJ, Bittner HB, Gummert JF, Walther T, Schewick CV, Girdauskas E, et al. On-pump beating heart versus off-pump coronary artery bypass surgery—evidence of pump-induced myocardial injury. European journal of cardio-thoracic surgery. 2005; 27(6):1057-64.
  20. Wang W, Wang Y, Piao H, Li B, Wang T, Li D, et al. Early and medium outcomes of on-pump beating-heart versus off-pump CABG in patients with moderate left ventricular dysfunction. Brazilian journal of cardiovascular surgery. 2019; 34(1):62-9.
  21. Xia L, Ji Q, Song K, Shen J, Shi Y, Ma R, et al. Early clinical outcomes of on-pump beating-heart versus off-pump technique for surgical revascularization in patients with severe left ventricular dysfunction: the experience of a single center. Journal of cardiothoracic surgery. 2017; 12(1):1-8.
  22. Erkut B, Dag O, Kaygin MA, Senocak M, Limandal HK, Arslan U, et al. On-pump beating-heart versus conventional coronary artery bypass grafting for revascularization in patients with severe left ventricular dysfunction: early outcomes. Canadian Journal of Surgery. 2013; 56(6):398.
  23. Hasde Aİ, Özçınar E, Çakıcı M, Baran Ç, İnan MB, Yazıcıoğlu L, et al. Comparison of aortic cross-clamping versus beating heart surgery in tricuspid valve repair. Turkish Journal of Thoracic and Cardiovascular Surgery. 2018; 26(4):519.
  24. Baraki H, Saito S, Al Ahmad A, Fleischer B, Haverich A, Kutschka I. Beating heart versus arrested heart isolated tricuspid valve surgery. International heart journal. 2015; 56(4):400-7.
  25. MarcoRanieriMD†DomenicoPaparellaMD GCLLTSV. Protective Effects of Steroids in Cardiac Surgery: A Meta-Analysis of Randomized Double-Blind Trials. Journal of Cardiothoracic and Vascular Anesthesia. 2011; 25(1).
  26. Dayan V, Paganini JJ, Marichal A, Brusich D. On-pump beating/non-beating CABG in stable angina have similar outcomes. Brazilian Journal of cardiovascular surgery. 2018; 33(2):183-8.
Iranian Heart Journal
Volume 24, Issue 1
January 2023
Pages 22-30

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