Denervation of pulmonary trunk and pulmonary orifice in patients with surgically corrected mitral valve disease against high pulmonary hypertension

Cover Page


Cite item

Full Text

Abstract

Aim: To study efficacy and safety of denervation of the trunk and pulmonary arteries (PADN procedure) in patients with surgical correction of the mitral valve against a high degree of pulmonary hypertension compared to those of the isolated correction of mitral valve disease.

Materials and methods: Placement of a mechanical mitral valve prosthesis and radiofrequency ablation Maze IV with Atri Cure ablator was performed in 39 patients with a mitral valve disease and high pulmonary hypertension (> 40 mm Hg) and atrial fibrillation. From those, 8 patients (main group) had additional circular denervation of the ganglionic plexus of the pulmonary trunk and orifice (PADN) with a radiofrequency bipolar Atri Cure ablator under the control of transmurality.

Results: All patients who had underwent surgery showed positive changes of the echocardiographic parameters, such as a decrease in the heart cavities sizes, degree of pulmonary hypertension, and an improvement in the systolic function of the left ventricle. There were no deaths, as well as specific complications related to the PADN procedure. In the main group of patients (n = 8), pulmonary hypertension decreased from 56.3 ± 5.4 mm Hg to 23.4 ± 2.7 mm Hg at day 1, to 24.3 ± 3.1 mm Hg at day 7, and to 23.7 ± 3.8 mm Hg at 1 month after the PADN procedure. At day 1, the target levels of pulmonary hypertension were achieved in 87.5% (7/8) of patients in the main study group and in 25.8% (8/31) of patients in the control group (p = 0.001). At day 7, the corresponding values were 75% (6/8) and 32.3% (10/31), respectively. Better results in the main study group were observed throughout the whole follow-up period (up to 2 months).

Conclusion: The circular PADN procedure using a radio frequency bipolar ablator under the control of transmurality is an effective and safe method to correct a high-degree pulmonary hypertension. Further studies on the effectiveness of this procedure in larger patient numbers and assessment of long-term results are necessary.

About the authors

N. A. Trofimov

Republican Cardiology Dispensary

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

MD, PhD, Cardiovascular Surgeon

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation. Tel.: +7 (8352) 56 10 03

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

209 Vaneeva ul., Nizhny Novgorod, Nizhegorodskaya oblast', 603950, Russian Federation. Tel.: +7 (831) 417 77 90

Russian Federation

A. G. Dragunov

Republican Cardiology Dispensary

Email: fake@neicon.ru

MD, PhD, Head of Department of Cardiac Surgery No. 2

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation

Russian Federation

V. E. Babokin

Moscow Regional Research and Clinical Institute (MONIKI)

Email: babokin@bk.ru

MD, PhD, Head of Department of Cardiac Surgery

61/2 Shchepkina ul., Moscow, 129110, Russian Federation. Tel.: +7 (495) 631 72 23

Russian Federation

A. V. Nikol'skiy

Nizhny Novgorod State Medical Academy

Email: fake@neicon.ru

MD, PhD, Cardiovascular Surgeon

10/1 ploshchad' Minina i Pozharskogo, Nizhny Novgorod, Nizhegorodskaya oblast', 603005, Russian Federation

Russian Federation

T. N. Mizurova

Republican Cardiology Dispensary

Email: fake@neicon.ru

MD, Cardiologist, Chief Physician

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation

Russian Federation

M. V. Gartfelder

Republican Cardiology Dispensary

Email: fake@neicon.ru

MD, Cardiovascular Surgeon

29А Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation

Russian Federation

A. V. Orlova

Federal Center of Traumatology, Orthopaedics and Prosthetics (Cheboksary)

Email: fc@orthoscheb.com

MD, PhD, Specialist in Medical Methodology

33 Fedora Gladkova ul., Cheboksary, Chuvash Republic, 428020, Russian Federation. Tel.: +7 (8352) 30 57 57

Russian Federation

References

  1. Hurdman J, Condliffe R, Elliot CA, Davies C, Hill C, Wild JM, Capener D, Sephton P, Hamilton N, Armstrong IJ, Billings C, Lawrie A, Sabroe I, Akil M, O'Toole L, Kiely DG. ASPIRE registry: assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre. Eur Respir J. 2012;39(4): 945–55. doi: 10.1183/09031936.00078411.
  2. Трофимов НА, Медведев АП, Бабокин ВЕ, Жамлиханов НХ, Драгунов АГ, Гартфельдер МВ, Николаева ОВ, Драгунова МВ. Эффективность оперативного лечения митральной недостаточности, с фибрилляцией предсердий неишемической этиологии. Медицинский альманах. 2014;(5): 165–9.
  3. Трофимов НА, Медведев АП, Бабокин ВЕ, Демарин ОИ, Жамлиханов НХ, Драгунов АГ, Гартфельдер МВ, Николаева ОВ, Драгунова МВ, Елдырев АЮ, Владимирова ТН. Хирургическое лечение сложных нарушений ритма у пациентов с митральной недостаточностью неишемической этиологии. Альманах клинической медицины. 2015;(38): 64–73. doi: 10.18786/2072-0505-2015-38-64-73.
  4. Астапов ДА, Караськов АМ, Семенова ЕИ, Демидов ДП. Протезирование митрального клапана биологическими протезами: непосредственные и отдаленные результаты. Хирургия. Журнал им. Н.И. Пирогова. 2013;(9): 18–23.
  5. Трофимов НА, Медведев АП, Бабокин ВЕ, Демарин ОИ, Жамлиханов НХ, Драгунов АГ, Гартфельдер МВ, Николаева ОВ, Драгунова МВ. Улучшение результатов хирургической коррекции сложных нарушений ритма и профилактика их рецидива у кардиохирургических пациентов. Альманах клинической медицины. 2015;(38): 74–80. doi: 10.18786/2072-0505-2015-38-74-80.
  6. Тулеутаев РМ, Богачев-Прокофьев АВ, Железнев СИ, Афанасьев АВ, Караськов АМ. Обратное ремоделирование левых камер сердца после реконструкции митрального клапана при мезенхимальной дисплазии. Патология кровообращения и кардиохирургия. 2015;19(1): 66–71. doi: http://dx.doi.org/10.21688/1681-3472-2015-1-66-71.
  7. Трофимов НА, Медведев АП, Мизурова ТН, Драгунов АГ, Кичигин ВА, Елдырев АЮ, Орлова АВ, Жильцов ДД, Демарин ОИ. Предикторы возникновения и рецидива фибрилляции предсердий у пациентов с митральной недостаточностью неишемической этиологии. Медицинский альманах. 2016;(4): 68–73. doi: http://dx.doi.org/10.21145/2499-9954-2016-4-68-73.
  8. Vahanian A, Alfieri O, Andreotti F, Antunes MJ, Barón-Esquivias G, Baumgartner H, Borger MA, Carrel TP, De Bonis M, Evangelista A, Falk V, Lung B, Lancellotti P, Pierard L, Price S, Schäfers HJ, Schuler G, Stepinska J, Swedberg K, Takkenberg J, Von Oppell UO, Windecker S, Zamorano JL, Zembala M; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio- Thoracic Surgery (EACTS). Eur J Cardiothorac Surg. 2012;42(4):S1– 44. doi: 10.1093/ejcts/ezs455.
  9. Babokin V, Shipulin V, Batalov R, Popov S. Surgical ventricular reconstruction with endocardectomy along radiofrequency ablation- induced markings. J Thorac Cardiovasc Surg. 2013;146(5): 1133–8. doi: 10.1016/j.jtcvs.2012.08.067.
  10. Rubin LJ. Primary pulmonary hypertension. N Engl J Med. 1997;336(2): 111–7. doi: 10.1056/NEJM199701093360207.
  11. Galiè N, Manes A, Negro L, Palazzini M, Bacchi-Reggiani ML, Branzi A. A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Eur Heart J. 2009;30(4): 394–403. doi: 10.1093/eurheartj/ehp022.
  12. Hoeper MM, Barberà JA, Channick RN, Hassoun PM, Lang IM, Manes A, Martinez FJ, Naeije R, Olschewski H, Pepke-Zaba J, Redfield MM, Robbins IM, Souza R, Torbicki A, McGoon M. Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J Am Coll Cardiol. 2009;54(1 Suppl):S85–96. doi: 10.1016/j.jacc.2009.04.008.
  13. Osorio J, Russek M. Reflex changes on the pulmonary and systemic pressures elicited by stimulation of baroreceptors in the pulmonary artery. Circ Res. 1962;10:664–7. doi: https://doi.org/10.1161/01.RES.10.4.664.
  14. Cech S. Adrenergic innervation of blood vessels in the lung of some mammals. Acta Anat (Basel). 1969;74(2): 169–82.
  15. Juratsch CE, Jengo JA, Castagna J, Laks MM. Experimental pulmonary hypertension produced by surgical and chemical denervation of the pulmonary vasculature. Chest. 1980;77(4): 525–30. doi: http://dx.doi.org/10.1378/chest.77.4.525.
  16. Baylen BG, Emmanouilides GC, Juratsch CE, Yoshida Y, French WJ, Criley JM. Main pulmonary artery distention: a potential mechanism for acute pulmonary hypertension in the human newborn infant. J Pediatr. 1980;96(3 Pt 2): 540–4.
  17. Chen SL, Zhang YJ, Zhou L, Xie DJ, Zhang FF, Jia HB, Wong SS, Kwan TW. Percutaneous pulmonary artery denervation completely abolishes experimental pulmonary arterial hypertension in vivo. EuroIntervention. 2013;9(2): 269–76. doi: 10.4244/EIJV9I2A43.
  18. Chen SL, Zhang FF, Xu J, Xie DJ, Zhou L, Nguyen T, Stone GW. Pulmonary artery denervation to treat pulmonary arterial hypertension: the single-center, prospective, first- in-man PADN-1 study (first-in-man pulmonary artery denervation for treatment of pulmonary artery hypertension). J Am Coll Cardiol. 2013;62(12): 1092–100. doi: 10.1016/j.jacc.2013.05.075.
  19. Song X, Zhang C, Chen X, Chen Y, Shi Q, Niu Y, Xiao J, Mu X. An excellent result of surgical treatment in patients with severe pulmonary arterial hypertension following mitral valve disease. J Cardiothorac Surg. 2015;10:70. doi: 10.1186/s13019-015-0274-1.
  20. Briongos Figuero S, Moya Mur JL, García-Lledó A, Centella T, Salido L, Aceña Navarro Á, García Martín A, García-Andrade I, Oliva E, Zamorano JL. Predictors of persistent pulmonary hypertension after mitral valve replacement. Heart Vessels. 2016;31(7): 1091–9. doi: 10.1007/s00380-015-0700-2.
  21. Богачев-Прокофьев АВ, Железнев СИ, Афанасьев АВ, Фоменко МС, Демидов ДП, Шарифулин РМ, Пивкин АН, Астапов ДА, Семенова ЕИ, Иванов СН, Караськов АМ. Аблация ганглионарных сплетений легочной артерии при хирургическом лечении пороков митрального клапана у пациентов с высокой легочной гипертензией. Патология кровообращения и кардиохирургия. 2015;19(4): 19–25. doi: http://dx.doi.org/10.21688/1681-3472-2015-4-19-25.
  22. Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise JS, Solomon SD, Spencer KT, Sutton MS, Stewart WJ; Chamber Quantification Writing Group; American Society of Echocardiography's Guidelines and Standards Committee; European Association of Echocardiography. Recommendations for chamber quantification: a report from the American Society of Echocardiography's Guidelines and Standards Committee and the Chamber Quantification Writing Group, developed in conjunction with the European Association of Echocardiography, a branch of the European Society of Cardiology. J Am Soc Echocardiogr. 2005;18(12): 1440–63. doi: 10.1016/j.echo.2005.10.005.
  23. Боровиков ВП. STATISTICA: искусство анализа данных на компьютере. 2-е изд. СПб: Питер; 2003. 688 с.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2017 Trofimov N.A., Medvedev A.P., Dragunov A.G., Babokin V.E., Nikol'skiy A.V., Mizurova T.N., Gartfelder M.V., Orlova A.V.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.

This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies