HYBRID EVENT: You can participate in person at Paris, France or Virtually from your home or work.

3rd Edition of International Heart Congress

June 05-07,2025 | Hybrid Event

June 05 -07, 2025 | Rome, Italy
Heart Congress 2024

Mitral stenoses complicated by massive thromboses of left atrium

Olexandr Bolshak, Speaker at Heart Conferences
Amosov National Institute of Cardiovascular Surgery, Ukraine
Title : Mitral stenoses complicated by massive thromboses of left atrium

Abstract:

Objective: To analyzed main problems  in surgery of  mitral valve diseases (MVD) complicated by left atrium`s massive thromboses (LAMT) (thromboses more than 1/3 of left atrium`s volume). 
Materials And Methods 336 adult patients (pts) with MVD complicated LAMT were consequtive operated from 01.01.1984 till 01.01.2020 yy in  Institute. Predominant genesis of MVD  was rheumatism. Mitral stenoses was marked in all  pts and  all of them were in IV NYHA class. There were male 147 (43,7%) and females 189 (56,3%).The average age was 59,2±5,2 yy. Preoperative thromboembolic episodes were in 59 (17,6%) pts. Calcification of MV was in 197 (58,6%) pts. Previous closed mitral commissurotomy was occurred in 35(10,3%) pts.  The  following procedures were performed: MVR (n = 294) including plastic procedure on TV  by De Vega (n = 35); 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 =162) maternal thrombotic basement was removal together with all thrombotic masses out of LA, group B (n =174) maternal thrombotic basement wasn`t removal. There were used bileaflet prosthesis (Saint Jude Medical, Carbomedics, On-X, ATS) (n=140); monodisc (n=98), Star-Edwards (ball) (n=38), Amosov`s model (hemiball) (n=18). Absence of applying donor blood product during all postoperative period was  19,5%.
Results: The hospital mortality (HM) at the period (1994-2014 yy) was 4,5% (n =9/198) for MVR and  0% (n = 0/29) for OMC.  The reasons of deaths were: heart failure (n=4), brain damage (thrombemboli)(only group B) (n=3), MOF (n = 1), bleeding (n=1 group A). Traumatic rupture of LA`s wall during radical removing of maternal thrombotic basement as specific complication was marked in 2,5% (n=4/162) pts. At all period of experience thromboembolic events were marked: group A – 1,8% (n = 3/162) (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= 12/294), (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). 282 (95,5% alive) pts was followed-up at the remote period (average 16,2 ± 3,1 yy). At all period of experience thromboembolic events were marked for bileaflet prosthesis: Saint Jude  - 1,5% (lethal = 0,7%), remote period - 3,6%  (lethal – 0,9%), Carbomedics  – 4,3% (lethal -  2,7%), remote period - 6,5%  (lethal - 2,2%), On-X   – 2,4% (lethal = 2,3%), remote period - 4,2% (lethal - 0), group ATS (n=32 pts) – 6,2%  (lethal = 3,1%), remote period - 9,3%  (lethal - 6,3%) (p < 0,05). 
Conclusion: Thromboembolic events at postoperative period is specific complicated factor  for LAMT. Maternal thrombotic basement must be removed with all thrombotic masses in all pts. Mechanical valve is independent risk-factor at postoperative period except model Saint Jude.

Biography:

I am a senior researcher at the Department of Acquired Valvular Heart Diseases of Amosov National Institute of Cardiovascular Surgery (Kyiv, Ukraine), cardiosurgeon. My experience in scientific and practical work is more than 20 years.

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