MP64. Surgical Treatment of Isolated Mitral Stenoses Complicated By Massive Thromboses of Left Atrium
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 analyzed main problem in surgery of mitral stenoses (MS) complicated by left atrium`s massive thromboses (LAMT) (thromboses more than 1/3 of left atrium`s volume not including volume of LA`s auriculum).
MATERIALS AND METHODS. 356 adult patients (pts) with MS complicated by LAMT were consequtive operated from 01.01.1984 till 01.01.2022 yy in Institute. Predominant genesis of MS was rheumatism and all pts and all of them were in IV NYHA class. There were male 157 (44,7%) and females 189 (55,3%).The average age was 59,2±5,2 yy. Preoperative thromboembolic episodes were in 59 (17,1%) pts. Calcification of MV was in 197 (57,6%) pts. Previous closed mitral commissurotomy was occurred in 137(5,0%) pts. The following procedures were performed: MVR (n = 314) including plastic procedure on TV by De Vega (n = 75); open mitral commissurotomy (OMC) (n =42) including plastic procedure on TV (n = 7). Only mechanical valves were used. All operations were performed with CPB, moderate hypothermia, ante-retrograde crystalloid cardioplegia (Custadiol). All pts was devided on 2 groups; group A (n =182) maternal thrombotic basement was removal together with all thrombotic masses out of LA, group B (n =174) maternal thrombotic basement in LA wasn`t removal but only thrombotic masses.
RESULTS. The hospital mortality (HM) at the period (01.01.1994-01.01.2022 yy) was 4,1% (n =9/230) for MVR and 0% (n = 0/29) for OMC (p<0,05). The reasons of deaths were in group A - HM – (n = 4/141 ) heart failure (n=2), MOF (n = 1), bleeding (n=1). The reasons of deaths were in group B - HM – (n = 5/89 ) brain damage (thrombemboli) (n=4), MOF (n = 1).
Traumatic rupture of LA`s wall during radical removing of maternal thrombotic basement as specific complication was marked in 2,7% (n=5/182)( group A) and 0% (n=0/174) (group B) (p<0,05).
At all period of experience thromboembolic events were marked: group A – 1,6% (n = 3/172) (lethal = 0), remote period - 3,6% (n = 5/140) (lethal -1,4%), group B – 5,8% (n = 10/174) (lethal- 3,4% ), remote period - 13,3% (n = 19/142) (lethal - 9,2%) (p < 0,05). At all period of experience thromboembolic events were marked: MVR in 4,1 % (n= 12/304), (lethal -1,0%), remote period - 8,9% (n = 22/245) (lethal -5,7%) and during OMC 2,4% (n= 1/42), (lethal -0), remote period - 5,4% (n = 2/37) (lethal -2,7%) (p < 0,05). 292 pts was followed-up at the remote period (average 16,2 ± 7,1 yy).
CONCLUSION. Thromboembolic events at post
MATERIALS AND METHODS. 356 adult patients (pts) with MS complicated by LAMT were consequtive operated from 01.01.1984 till 01.01.2022 yy in Institute. Predominant genesis of MS was rheumatism and all pts and all of them were in IV NYHA class. There were male 157 (44,7%) and females 189 (55,3%).The average age was 59,2±5,2 yy. Preoperative thromboembolic episodes were in 59 (17,1%) pts. Calcification of MV was in 197 (57,6%) pts. Previous closed mitral commissurotomy was occurred in 137(5,0%) pts. The following procedures were performed: MVR (n = 314) including plastic procedure on TV by De Vega (n = 75); open mitral commissurotomy (OMC) (n =42) including plastic procedure on TV (n = 7). Only mechanical valves were used. All operations were performed with CPB, moderate hypothermia, ante-retrograde crystalloid cardioplegia (Custadiol). All pts was devided on 2 groups; group A (n =182) maternal thrombotic basement was removal together with all thrombotic masses out of LA, group B (n =174) maternal thrombotic basement in LA wasn`t removal but only thrombotic masses.
RESULTS. The hospital mortality (HM) at the period (01.01.1994-01.01.2022 yy) was 4,1% (n =9/230) for MVR and 0% (n = 0/29) for OMC (p<0,05). The reasons of deaths were in group A - HM – (n = 4/141 ) heart failure (n=2), MOF (n = 1), bleeding (n=1). The reasons of deaths were in group B - HM – (n = 5/89 ) brain damage (thrombemboli) (n=4), MOF (n = 1).
Traumatic rupture of LA`s wall during radical removing of maternal thrombotic basement as specific complication was marked in 2,7% (n=5/182)( group A) and 0% (n=0/174) (group B) (p<0,05).
At all period of experience thromboembolic events were marked: group A – 1,6% (n = 3/172) (lethal = 0), remote period - 3,6% (n = 5/140) (lethal -1,4%), group B – 5,8% (n = 10/174) (lethal- 3,4% ), remote period - 13,3% (n = 19/142) (lethal - 9,2%) (p < 0,05). At all period of experience thromboembolic events were marked: MVR in 4,1 % (n= 12/304), (lethal -1,0%), remote period - 8,9% (n = 22/245) (lethal -5,7%) and during OMC 2,4% (n= 1/42), (lethal -0), remote period - 5,4% (n = 2/37) (lethal -2,7%) (p < 0,05). 292 pts was followed-up at the remote period (average 16,2 ± 7,1 yy).
CONCLUSION. Thromboembolic events at post