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 – 2021 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 438 (96,5%) pts and MV plasty in 16 (3,5%). 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 + resection 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 ± 14,2 – and group B - 55,1 ± 11,3 (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, persisted at discharge: group A - 21,6%, and group B - 5,2% remote period – 3,1% (p<0,05). At the remote period (average was 7,3± 3,2 yy) 437 (93,2%) pts were followed–up. Data of echo for group A were: diameter of LA (mm) - preoperative (PRE) - 57,9 ± 0,9, postoperative (POST) - 48,3 ± 0,8, remote period (RP) - 49,5 ± 0,6; ejection fraction of LV (EFLV): PRE – 0,54 ± 0,05, POST - 0,57 ± 0,03, RP - 0,59 ± 0,02 . At the remote period (n=110) thromboembolic events were marked in 6,2% (n=9/110) and lethal events was occured in 0,9% (n=1/110) pts.Data of echo for group B were: diameter of LA (mm): PRE- 57,4 ± 0,6 , POST - 55,2 ± 0,8, RP - 63,2 ± 1,1; EFLV: PRE – 0,54 ± 0,05 , POST - 0,55 ± 0,05, RP – 0,53± 0,05 . At the remote period thrombembolic events were marked in 16,8% and respectively lethal - 7,0% (n =23/ 327)
