ARCH PLASTY OF LEFT ATRIUM FOR MODERATE DILATATION OF LEFT ATRIUM: IS IT NECESSARY?

MP005 

Abstract Submission 

Volodymyr Popov (1), Valery Boukarim (2), Katerina Pukas (3), Anatoly Rudenko (3)

(1) National Institute of cardio-vascular surgery named after Amosov, Kiev, Kiev, (2) ukrainian, kyiv, NA, (3) ukrainian, kiev, NA

Volodymyr Popov    -  Contact Me
National Institute of cardio-vascular surgery named after Amosov

Valery Boukarim    -  Contact Me
ukrainian

Katerina Pukas    -  Contact Me
ukrainian

Anatoly Rudenko    -  Contact Me
ukrainian

Volodymyr Popov    -  Contact Me
National Institute of cardio-vascular surgery named after Amosov

OBJECTIVE. To determined possibillities of left atrium (LA)`s reduction by original method of arch plasty of LA (APLA) during mitral valve replacement (MVR) for isolated mitral valve disease (MVD).
METHODS. During 2005 – 2021 yy. 454 adult patients (pts) with MVD and LA`s moderate dilatation of LA (diameter of LA 50 < 60) average 57,1 ± 0,5 mm were operated at Institute. MVR were performed in all pts. There were 194 (42,7%) males, 260 (57,3%) females. Average age was 57,4 ± 6,9 yy. There were 239 (52,7%) in IY NYHA class, 186 (41,0%) in III class and 29 (6,3%) in II class. The main reason of MVD was: rheumatism (69%). Atrial fibrillation was marked in all pts.
All data divided at 2 groups: group A - APLA + ligation of LA`s auriculum was 117 pts and group B – 337 pts only MVR without LA`s plasty or ligation`s auriculum were performed. All operations were used with CPB, moderate hypothermia with crystalloid cardioplegia. Cross-clamping time of aorta (minutes) were: group A - 61,1 ± 6,2 – and group B - 45,1 ± 4,3 (p< 0,05). Absence of using blood product in 64,5%.
RESULTS. The hospital mortality were: in group A - 0,9% (n=1/117) and in group B - 2,1% (n=7/337) (p<0,05). Reasons of deaths: group A - pneumonia (1pts ), group B – brain damage (thrombemboli) (3 pts), heart failure (3 pts), MOF (2 pts). Sinus rhythm was restored at discharge: group A - 21,6% and group B - 5,2%(p<0,05). At the remote period (average was 9,3± 1,4 yy) 437 (93,2%) pts were followed–up. Data of echo for group A were: diameter of LA (mm) - preoperative (PRE) - 57,9 ± 0,7, postoperative (POST) - 48,3 ± 0,4, remote period (RP) - 49,5 ± 0,4; ejection fraction of LV (EFLV): PRE – 0,54 ± 0,03, POST - 0,57 ± 0,03, RP - 0,59 ± 0,02 . At the remote period were marked absence of thromboembolic events and HF and sinus rhythm was occured in 13,5% pts.
Data of echo for group B were: diameter of LA (mm): PRE- 57,4 ± 0,5 , POST - 55,2 ± 0,8, RP - 62,2 ± 1,1; EFLV: PRE – 0,54 ± 0,04 , POST - 0,55 ± 0,03, RP – 0,53± 0,05 . Thrombembolic events and HF were marked at remote period respectively - 4,5% and 13,2%. AF was marked in all cases.
CONCLUSION. The original method of APLA was allowing to improve better clinical results at group A than in B during all postoperative period (p<0,05).

Mitral Valve Replacement