Salhiyyah Kareem, Taggart David
Department of Cardiothoracic Surgery, Royal Brompton and Harefield NHS Trust, London, UK.
Asian Cardiovasc Thorac Ann. 2009 Dec;17(6):650-8. doi: 10.1177/0218492309348942.
Beating-heart continuous coronary perfusion (BHCCP) has been promoted as an alternative to the technique of cardioplegic arrest in valve surgery. Its potential advantage is the elimination of cardioplegia and the corollary risk of ischemic reperfusion injury. The use of CCP has been recommended especially when performing more complex operations, such as mitral valve repair, and particularly as surgeons become more familiar with beating-heart coronary surgery. We conducted a systematic review to assess the strength of the evidence supporting the efficacy of BHCCP compared to cardioplegia in valve surgery. Thirty nine reports were identified. Of these, only two were randomized control trials. Overall the studies were generally of poor quality and had a low evidence level. In those studies, mortality and major morbidity from BHCCP were within acceptable levels, nevertheless, there was no advantage over cardioplegic arrest. On the other hand there is weak evidence that it may reduce functional and biochemical markers of myocardial injury. In conclusion, BHCCP is an operative strategy in valve surgery with some potential benefits. There is, however a need for a high quality, prospective, randomized control trial to establish the exact role for BHCCP in complex valve surgery.
不停跳冠状动脉持续灌注（BHCCP）已被推广为瓣膜手术中心脏停搏技术的替代方法。其潜在优势是消除了心脏停搏液及其伴随的缺血再灌注损伤风险。尤其在进行更复杂的手术（如二尖瓣修复）时，推荐使用持续冠状动脉灌注，特别是随着外科医生对不停跳冠状动脉手术越来越熟悉。我们进行了一项系统评价，以评估与心脏停搏相比，支持BHCCP在瓣膜手术中疗效的证据强度。共检索到39篇报告。其中，只有两篇是随机对照试验。总体而言，这些研究质量普遍较差，证据水平较低。在这些研究中，BHCCP的死亡率和主要并发症发生率在可接受范围内，然而，与心脏停搏相比并无优势。另一方面，有微弱证据表明它可能降低心肌损伤的功能和生化指标。总之，BHCCP是瓣膜手术中的一种手术策略，具有一些潜在益处。然而，需要进行高质量、前瞻性、随机对照试验，以确定BHCCP在复杂瓣膜手术中的确切作用。
