Title : Arch plasty of left atrium for moderate dilatation of left atrium during MV`s correction: Is it necessary?
Abstract:
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 – 2022 yy. 454 adult patients (pts) with MVD and LA`s moderate dilatation of LA (diameter of LA 50,0 < 60,0 mm) average 57,1 ± 0,8 mm were operated at Institute. . MVR were performed in 443 pts and MV`s plasty in 11. 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 (59%). Atrial fibrillation was marked in 83,7% 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- ?lamping time of aorta (minutes) were: group A - 71,1 ± 8,2 – and group B - 55,1 ± 6,3 (p< 0,05). Absence of using blood product during all hospital period was occured in 44,5%
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) (2 pts), heart failure (3 pts), MOF (3 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 8,3± 2,1 yy) 437 (93,2%) pts were followed–up.Data of echo for group A were: diameter of LA (mm) - preoperative (PRE) - 57,9 ± 4,7, postoperative (POST) - 48,3 ± 2,4, remote period (RP) - 49,5 ± 2,1; ejection fraction of LV (EFLV): PRE – 0,54 ± 0,03, POST - 0,57 ± 0,03, RP - 0,59 ± 0,04 . At the remote period (n = 110) thromboembolic events were marked in 6,2% including lethal 0% and HF in 3,1%. Sinus rhythm was occured in 15,5% pts. Data of echo for group B were: diameter of LA (mm): PRE- 57,4 ± 3,5 , POST - 55,2 ± 2,8, RP - 63,2 ± 3,5; EFLV: PRE – 0,54 ± 0,04 , POST - 0,55 ± 0,03, RP – 0,53± 0,05 . At the remote period (n = 327) thromboembolic events were marked 16,8% including lethal 8,2% and HF respectively - 17,5%. Sinus rhytm was marked in 3,1%
Conclusion The original method of APLA with ligation of left atrium`s auriculum was allowing to improve better clinical results at group A than in B during all postoperative period (p<0,05).
