Aortic root surgery in the beating heart: a case series

Aim: To describe the technique of surgical intervention on the aorta and aortic valve under working heart conditions with constant antegrade coronary myocardial perfusion and / or in combination with cardioplegic cardiac arrest; and also to assess the effectiveness of this method of myocardial protection and the possibility of its further use in aortic surgery.

Materials and methods: From March to November 2024, 12 patients underwent planned surgery at the S.G. Sukhanov Federal Center for Cardiovascular Surgery of the Ministry of Health of Russia (Perm). The average age was 57.75±9.8 years – 10 men (83.7%), 2 women (16.3%). All of them underwent off-pump aortic replacement: supracoronary aortic replacement (1 patient); supracoronary aortic replacement and aortic valve replacement (1 patient); supracoronary aortic replacement and coronary artery bypass grafting (CABG) using radiofrequency ablation (RFA) (1 patient); Bentall-De Bono procedure (1 patient); David procedure (7 patients). Two patients underwent surgical treatment through mini-J-sternotomy. One patient also underwent CABG. Among the patients, there were two with previous surgeries (CABG and MIDCAB). Two techniques were used: the first variant – full surgical intervention was performed on a beating heart using continuous antegrade coronary myocardial perfusion in 8 patients; the second variant – a combination of cardioplegic cardiac arrest with coronary myocardial perfusion on a beating heart – 4 patients.

During  the  study  period,  no  patient  died.  Postoperative  parameters  (cardiac  markers,  electrocardiography  (ECG), echocardiography) remained within normal limits. A number of complications were noted: one case of atrial fibrillation, terminated within the first day, one case of ventricular flutter intraoperatively with rhythm restoration after defibrillation, one case of mediastinal revision for hemostasis    

Results. During the study period, no patient died. Postoperative parameters (cardiac markers, ECG, echocardiography(EchoCG)) remained normal. The following complications were noted: 1 case of atrial fibrillation, terminated within the first day, 1 case of ventricular fibrillation intraoperatively with rhythm restoration after defibrillation, 1 case of mediastinal revision for hemostasis.

Conclusion. Considering satisfactory intra- and postoperative data of surgical treatment of patients with aortic pathology on a beating heart with parallel cardiopulmonary bypass, as well as the absence of an increase in cardiac markers of myocardial damage in the perioperative period, we consider this technique applicable in surgical practice. Further development and use of the technique in aortic surgery on a beating heart using continuous antegrade coronary myocardial perfusion will reduce the myocardial stress during surgery, minimize the risks of postoperative complications and accelerate the patient's rehabilitation

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