SURGICAL TREATMENT OF COMPLEX ARRHYTHMIAS IN PATIENTS WITH NON-ISCHEMIC MITRAL INSUFFICIENCY

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Abstract

Aim: To analyze and improve efficacy of surgical treatment of patients with non-ischemic mitral insufficiency and atrial fibrillation.

Materials and methods: The study included 64 patients with degenerative mitral insufficiency complicated by atrial fibrillation who had surgical interventions from 2011 to 2014. Surgical treatment consisted of surgical correction of mitral regurgitation: mitral valve reconstruction (group 1, n = 133) and mechanical prosthesis (group 2, n = 31), as well as left atrium Maze IV procedure in “box lesion” modification with the use of AtriCure bipolar destructor in both groups.

Results: No postoperative deaths were registered. After surgery, all patients showed a decrease in all cardiac cavities’ sizes and of pulmonary hypertension, an improvement in left ventricular systolic function assessed by transthoracic echocardiography. During follow-up of up to 14 months’ duration, sinus rhythm was maintained in 56 (86%) of patients, whereas 9 patients had recurrent atrial fibrillation resistant to medications and electrical cardioversion. Patients, who had undergone valve preserving correction of mitral insufficiency and left atrium Maze IV procedure, had the best results as to contractility of left ventricle (7.86%), reduction of cardiac cavities’ size (end-diastolic dimension – 11.05%, end-systolic dimension – 15.15%, right atrium – 15.19%), especially that of left atrium (19.03%), reduction of pulmonary hypertension (27.75%) and significant improvement in quality of life (7 points) assessed by Minnesota Living with Heart Failure Questionnaire.

Conclusion: Plastic correction of mitral insufficiency with atrial fibrillation combined with Maze IV procedure gives the highest improvement of left ventricular contractility and diminishing of cavities compared to mitral valve replacement with mechanical prosthesis in combination with Maze IV procedure.

About the authors

N. A. Trofimov

Republican Cardiology Dispensary

Author for correspondence.
Email: nikolai.trofimov@mail.ru

Cardiovascular Surgeon

Russian Federation

A. P. Medvedev

Nizhny Novgorod State Medical Academy

Email: mail@skkbnn.ru

MD, PhD, Professor, Head of Chair of Hospital Surgery named after B.A. Korolyov

Russian Federation

V. E. Babokin

Moscow Regional Research and Clinical Institute (MONIKI)

Email: babokin@bk.ru

PhD, Head of Department of Cardiac Surgery

Russian Federation

O. I. Demarin

Nizhny Novgorod State Medical Academy

Email: fake@neicon.ru
Cardiovascular Surgeon Russian Federation

N. Kh. Zhamlikhanov

Municipal Pediatric Hospital No. 4

Email: fake@neicon.ru

MD, PhD, Professor, Chief Physician

Russian Federation

A. G. Dragunov

Republican Cardiology Dispensary

Email: fake@neicon.ru

PhD, Head of Department of Cardiac Surgery No. 2

Russian Federation

M. V. Gartfelder

Republican Cardiology Dispensary

Email: fake@neicon.ru

Cardiovascular Surgeon

Russian Federation

O. V. Nikolaeva

Republican Cardiology Dispensary

Email: fake@neicon.ru
Cardiologist Russian Federation

M. V. Dragunova

Republican Cardiology Dispensary

Email: fake@neicon.ru
Cardiologist Russian Federation

A. Yu. Eldyrev

Republican Cardiology Dispensary

Email: fake@neicon.ru

PhD, Specialist in Anesthesiology/Resuscitation

Russian Federation

T. N. Vladimirova

Republican Cardiology Dispensary

Email: fake@neicon.ru
Cardiologist Russian Federation

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Copyright (c) 2015 Trofimov N.A., Medvedev A.P., Babokin V.E., Demarin O.I., Zhamlikhanov N.K., Dragunov A.G., Gartfelder M.V., Nikolaeva O.V., Dragunova M.V., Eldyrev A.Y., Vladimirova T.N.

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