Клінічна хірургія (Oct 2021)
The arch-like plasty of the left atrium in correction of a mitral valve failure
Abstract
Objective. Studying the possibilities of the method of the left atrium arch-like plasty while correcting of a mitral failure in combination with the left atrium dilatation. Materials and methods. Into the analysis of the surgical treatment results in 190 patients, suffering mitral failure in combination with the left atrium dilatation, who were operated in the National Institute of Cardio-Vascular Surgery named after N. M. Amosov NAMS of Ukraine in a period from 01.01.2012 to 01.01.2021 yr, were included. The main group consisted of 103 patients, to whom correction of a mitral failure in combination with original procedure of the arch-like plasty of left atrium was performed. Into a control group 87 patients were included, to whom the correction of a mitral valve failure was done without concomitant plasty of left atrium. Results. Of 103 operated patients of the main group on the hospital stage 1 have died (0.9% lethality). Dynamics of echocardiographic indices on the treatment stages was following: definitely-systolic index of the left ventricle - (63.1 ± 11.3) ml/m2 (preoperatively), (58.3 ± 8.4) ml/m2 (postoperatively), (49.4 ± 9.2) ml/m2 (remote period); the left ventricle ejection fraction: 0.52 ± 0.04 (preoperatively), 0.55 ± 0.04 (postoperatively), 0.57 ± 0.03 (remote period). Diameter of left atrium: (58.8 ± 6.4) mm (preoperatively), (41.4 ± 5.3) mm (postoperatively), (43.9 ± 2.3) mm (remote period). Sinus rhythm in a remote period was stable in 75 (78.9%) of 95 patients. Of 87 operated patients of a control group 2 died (lethality 2.3%). Dynamics of the echocardiographic indices on the treatment stages was following: definitely-systolic index of left ventricle- (67.3 ± 11.3) ml/m2 (preoperatively), (60.4 ± 9.3) ml/m2 (postoperatively), (52.7 ± 7.2) ml/m2 (remote period); the left ventricle ejection fraction: 0.52 ± 0.05 (preoperatively), 0.54 ± 0.05 (postoperatively), 0.54 ± 0.03 (remote period). Diameter of left atrium: (59.5 ± 2.3) mm (preoperatively), (57.5 ± 3.7) mm (postoperatively), (68.5 ± 3.4) mm (in remote period). Sinus rhythm was stable in 18 (22.5%) of 80 patients, followed in the remote period. Conclusion. The arch-like plasty of left atrium is a low-traumatic and effective procedure, leading to significant improvement of the left atrium morphometry and accompanied by low risk for postoperative lethality.
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