Title : Reconstruction of left part of the heart for combined mitral-aortic-tricuspid valve diseases
Abstract:
Objective: To determined possibillities of correction of the left parts of the heart by preservation of MV`s apparatus and concomitant reduction of left atrium (LA) during correction of combined mitral-aortic-tricuspid valve diseases (CMATD).
Methods: During 01.01.2006-01.01.2022 yy. 201 adult patients (pts) were operated with CMATD, giant diameter of LA (diameter 60 mm and more) and concomitant left ventriculomegaly (left ventricle`s end-diastolic volume 300 ml and more) at Institute. Average age was 57,2± 10,6 yy. 171 (85,1%) pts were in IY NYHA class and 30 (14,9%) in III class. All material divided at 2 groups: group A (n= 82): MAVR + LA`s plasty (all pts) + MVR with preservation of posterior leaflet (all pts) and additionally translocation of anterior leaflet`s papillary muscles (n=54)+ TV`s plasty; group B (control group) (n= 119): only MAVR without preservation of MV`s structure and without LA`s plasty+TV`s plasty. In both groups concomitant procedures were occured on reconstruction of the annuli of narrow ostium of aorta (n =5),, CABG (n =21).
Results: There were 3 deaths at the hospital period (hospital mortality (HM) - 3,6%) (group A). At the remote period (average was 9,3± 1,8 yy) 75 pts were followed –up. Sinus rhythm was preserved at 11 (14,7%) pts and there were 3 deaths . Unsatisfactive results were marked: myocardial infarction (n=2), thromboembolic event (n=1).
Data of echo for group A: end-systolic volume index (ESVI) (ml/m.sq.) - preoperative 78,8 ± 13,5, postoperative (6 -11 dd) - 59,8 ± 9,1 and at the remote period 49,6 ± 7,2 and diameter of LA (mm) preoperative - 63,4 ± 5,2, postoperative - 49,4 ±4,2, remote period - 51,8 ± 3,3.
There were 6 deaths at the hospital period (HM - 5,0%) (group B). At the remote period (average was 8,1± 1,5 yy) 99 pts were followed –up. Data of echo for group B: ESVI - preoperative 81,8 ± 12,2, postoperative (6 -11 dd) - 70,6 ± 13,4 and remote period 61,4 ± 9,2 and diameter of LA (mm) preoperative - 64,5 ± 5,2, postoperative - 62,4 ± 6,7, remote period – 74,1 ± 5,6. Sinus rhythm wasn`t marked in any pts and there were 13 deaths. Unsatisfactive results were marked: progressive heart failure(n=8), thromboembolic events (n=4).
conclusion: Reconstruction of the left part of the heart for CAMVD by preservation of MV and LA`s plasty during MAVR was allowing to improve indixes of LV`s and LA`s morphometry, contractility during early and at the remote period comparing with group B.
