MP05. Arch Plasty of Left Atrium for Moderate Dilation of Left Atrium: Is It Necessary?
Presented During: Moderated E-Posters
National Institute of cardio-vascular surgery named after Amosov
Kiev, Kiev
Ukraine - Contact Me
Dr. Popov Volodymyr, MD, PhD, Doctor of Medical Sciences, Professor.
Chief of department of surgery of acquired heart disease
Amosov National Institute of Cardiovascular Surgery
6, Mykoly Amosova St, Kyiv, 02000 Ukraine
mob. +380 67 402 24 39,
[email protected], www.vladpopov.kiev.ua
Thursday, May 4, 2023: 6:30 PM - Saturday, May 6, 2023: 2:29 AM
New York Hilton Midtown
Room: Grand Ballroom Foyer
Description
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).
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).