Title : Triangular plasty of left atrium for atriomegaly during mitral valve correction: Is it neccesary?
Abstract:
Objective. To determined possibillities of left atrium (LA)`s reduction by original method of triangular plasty of LA (TPLA) during mitral valve replacement (MVR) for isolated mitral valve disease (MVD).
Methods. During 2005 – 2022 yy. 725 adult patients (pts) with MVD and LA`s atriomegaly (diameter of LA > 60 mm) average 68,4 ± 5,8 were operated at Institute. MVR were performed in 687 pts and MV`s plasty in 38. There were 330 (45,5%) males, 395 (54,5%) females. Average age was 55,5 ± 8,9 yy. There were 448 (61,8%) in IY NYHA class and 277 (38,2%) in III class. All data divided at 2 groups: group A - TPLA + ligation of LA`s auriculum was 148 pts and group B – 577 pts only MVR without LA`s plasty or ligation`s auriculum. All operations were performed with CPB, moderate hypothermia with crystalloid cardioplegia. Cross-clamping time of aorta (min) were: group A - 77,4 ± 8,6 and group B - 51,2 ± 4,9 (p< 0,05)
Results. The hospital mortality were: in group A - 2,0% (n=3/148) and in group B - 2,6% (n=15/577) (p<0,05). At the remote period (average was 8,2± 1,3 yy) 651 (91,7%) pts were followed–up. Data of echo for group A: diameter of LA (mm) - preoperative (PRE) - 63,2 ± 5,3, postoperative (POST) - 51,6 ± 3,8, remote period (RP) - 52,2 ± 2,7; ejection fraction of LV (EFLV): PRE – 0,52 ± 0,05, POST - 0,55 ± 0,04, RP - 0,58 ± 0,03. Data of echo for group B were: diameter of LA (mm): PRE- 68,5 ± 5,2 , POST - 69,3 ± 4,8, RP - 77,1 ± 5,1; EFLV: PRE – 0,53 ± 0,04 , POST - 0,54 ± 0,05, RP – 0,47 ± 0,04 . At remote period thromboembolic events and heart failure were marked respectively: in group A -1,7% and 2,9% and in group B – respectively 7,5% and 27,2% (p<0,05).
Conclusion. The original method of TPLA was allowing to improve better clinical results at group A than in B (p<0,05)
