Gerardo AK Laksono, Heroe Soebroto, Paul L Tahalele


Introduction: Reperfusion injury is a well-known phenomenon that occurred in cardioplegic techniques with cardiopulmonary bypass. Therefore great effort is made to prevent reperfusion injury. Beating Heart Continuous Coronary Perfusion (BHCCP) surgery is one of the alternative techniques to improve an ischemic reperfusion injury in open-heart surgery, either in pediatric or in adult. This technique can be done in complete repair of tetralogy of Fallot (TOF). Purpose: To report our first experience in doing complete repair of TOF using beating heart technique without aortic cross-clamping Case Report: A five-year-old boy came on to ER on January 6th, 2012, with a history of cyanotic since birth. His echocardiography and catheterization concluded a tetralogy of Fallot with a McGoon ratio of 1.95 (the diameter of RPA and LPA were 9.14 mm and 8.79 mm, respectively). A complete repair of TOF was done using beating heart surgery without aortic cross-clamping technique. One month post-surgery evaluation, there weren't any neurological or motor disorders. Echocardiography results showed no residual pulmonary stenosis, but 0.2 mm residual VSD was found. Conclusion: This heart rate technique is an alternative method of myocardial protection in cardiac surgery. In several cardiac centres globally, this technique is relatively safe and can be used during surgery, especially in the total correction of TOF.

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Tetralogy of Fallot; TOF; Beating Heart Continous Cornary Perfusion; Beating Heart Surgery

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Babaroglu S, Yay K, Parlar AI, Ates C, Mungan U, Cicekcioglu F, et al. Beating heart versus conventional mitral valve surgery. Interactive cardiovascular and thoracic surgery. 2011;12(3):441-7. Epub 2010/12/24.

Jonas AR HR, La Pierre R, Matte G, editor. Myocardial protection. first ed. Great Britain: Hodder Arnold, An Hachette UK company 2004.

Mehlhorn U, Allen SJ, Adams DL, Davis KL, Gogola GR, Warters RD. Cardiac surgical conditions induced by beta-blockade: effect on myocardial fluid balance. Ann Thorac Surg 1996;62:143–150.

Mo A, Lin H, Wen Z, Lu W, Long X, Zhou Y. Efficacy and Safety of On-Pump Beating Heart Surgery. Ann Thorac Surg 2008;86:1914-8.

Hui L, Wei H, Shifeng W, et al. Aortic valve replacement on the beating heart with continuous retrograde coronary sinus perfusion. J Guangxi Med Univ 1996;13:4–6.

Gersak B, Sutlic Z. Aortic and mitral valve surgery on the beating heart is lowering cardiopulmonary bypass and aortic cross clamp time. Heart Surg Forum 2002;5:182– 6.

Gersak B. Mitral valve repair or replacement on the beating heart. Heart Surg Forum 2000;3:232–7.

Yingbing X, Lin C, Xuefeng W, et al. On-pump beating-heart intracardiac procedures in 2100 cases. Chin J ECC 2006;4: 210–2.

Hui L, Wei H, Qingyun P, et al. Aortic valve and mitral valve replacement with retrograde coronary sinus perfusion on beating heart. Chin J Thorac Cardiovasc Surg 2001;17: 129–31.

Photiadis J, Asfour B, Sinzobahamvya N, et al. Improved hemodynamics and outcome after modified Norwood operation on the beating heart. Ann Thorac Surg 2006;81:976–81.

Panos A, Myers PO, Kalangos A. Novel technique for aortic arch surgery under mild hypothermia. Ann Thorac Surg 2008;85:347– 8.

Battellini R, Rastan AJ, Fabricius A, Moscoso-Luduena M, Lachmann N, Mohr FW. Beating heart aortic valve replacement after previous coronary artery bypass surgery with a patent internal mammary artery graft. Ann Thorac Surg 2007;83:1206 –9.

Cicekcioglu F, Tutun U, Babaroglu S, et al. Aortic valve replacement with on-pump beating heart technique. J Card Surg 2007;22:211– 4.

Wang J, Liu H, Xiang B, et al. Keeping the heart empty and beating improves preservation of hypertrophied hearts for valve surgery. J Thorac Cardiovasc Surg 2006;132:1314 –20.

Behr L, Chetboul V, Sampedrano CC, et al. Beating heart mitral valve replacement with a bovine pericardial bioprosthesis for treatment of mitral valve dysplasia in a bull terrier. Vet Surg 2007;36:190–8.

Kaukoranta P, Lepojärvi M, Nissinen J, Raatikainen P, Peuhkurinen KJ. Normothermic versus mild hypothermic retrograde blood cardioplegia: a prospective, randomized study. Ann Thorac Surg 1995;60:1087–93.

Karadeniz U, Erdemli O, Yamak B, et al. On-pump beatingheart versus hypothermic arrested heart valve replacement surgery. J Card Surg 2008;23:107–13.

Salerno TA, Panos AL, Tian G, Deslauriers R, Calcaterra D. Ricci M. Surgery for cardiac valves and aortic root without cardioplegic arrest (“beating heart”): experience with a new method of myocardial perfusion. J Card Surg 2007;22:459–64