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

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.

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.

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]).

The beating-heart surgical procedure conferred a better EF at discharge. Additionally, cardiac troponin I and creatine phosphokinase levels decreased after the preoperative time.