Mitral Valve Surgery
Conditions
Brief summary
Mitral valvuloplasty for correction of chronic mitral regurgitation carries a lower operative mortality and morbidity and improved long-term survival than does mitral valve replacement. Unfortunately, mitral valvuloplasty is not possible in all patients with chronic mitral regurgitation because of unfavorable pathology or lack of experience with this technique
Detailed description
Cardioplegia is a fundamental component in providing heart protection, limiting metabolic activity and increasing the myocardium's capacity to resist ischemia for prolonged periods, thus being essential for good surgical outcomes. Numerous cardioplegia solutions exist with different compositions to provide sufficient myocardial protection. However, there is no standard for the optimal or ideal composition and delivery technique. Cardioplegia solutions are crystalloid or blood-based solutions with various chemical compounds. Despite improvements in myocardial protection, prosthetic valves, surgical techniques, and postoperative care, the operative mortality and morbidity of mitral valve replacement for chronic mitral regurgitation remains high in comparison with other commonly performed heart operations. The timing of the administration of cardioplegia is extremely important in terms of preventing myocardial dysfunction. Conventional multidose cardioplegias should be repeatedly administered in every 15 to 20 min. Frequent interruption of the surgical process, even for a short time, before each cardioplegia delivery leads to a loss of time during open heart surgery, where time is extremely important, and disrupts the coherence of the operation and the surgical concentration. Crystalloid cardioplegic solutions achieve cardioplegic arrest through inhibition of either fast-acting sodium channels or calcium-activated mechanisms. Hyperkalemia can be used to inhibit the fast-acting sodium channels as it is in the St.Thomas Hospital solution and its modifications.
Interventions
DRUGCrystalloid Cardioplegic solution
To compare between conventional crystalloid cardioplegia with modified del Nido cardioplegia in mitral valve regurge replacement surgery.
Sponsors
Al-Azhar University
mohamed
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
TREATMENT
Masking
NONE
Eligibility
Sex/Gender
ALL
Age
21 Years to 50 Years
Healthy volunteers
No
Inclusion criteria
\- Patients scheduled for elective Mitral regurge replacement Surgery with normal Coronaries
Exclusion criteria
1. Patients with chronic renal disease (previous medical diagnosis or serum creatinine greater than 1.5mg/dL) 2. Left ventricular ejection fraction less than 50%. 3. Previous cardiac surgery 4. Patient with BMI \> 30 5. Severe psychiatric illness 6. Inability or unwillingness to give informed consent for participation
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| myocardial protection | from baseline to 24 hours after the operation | Number of Participants With myocardial protection through measurements of the serum levels of the cardiac enzymes just after operation |
Countries
Egypt
Outcome results
None listed