PREDICTORS OF LOW EFFICIENCY OF PULMONARY ARTERY DENERVATION PROCEDURE IN PATIENTS WITH MITRAL VALVE DISEASES COMPLICATED BY ATRIAL FIBRILLATION AND PULMONARY HYPERTENSION

N. A. Trofimov; A. P. Medvedev; V. E. Babokin; I. P. Efimova; A. G. Dragunov; V. A. Kichigin; A. V. Nikolsky; R. G. Tabaev; M. V. Davydenko; A. I. Preobrazhensky; Yu. A. Sobolev

PREDICTORS OF LOW EFFICIENCY OF PULMONARY ARTERY DENERVATION PROCEDURE IN PATIENTS WITH MITRAL VALVE DISEASES COMPLICATED BY ATRIAL FIBRILLATION AND PULMONARY HYPERTENSION

N. A. Trofimov, A. P. Medvedev, V. E. Babokin, I. P. Efimova, A. G. Dragunov, V. A. Kichigin, A. V. Nikolsky, R. G. Tabaev, M. V. Davydenko, A. I. Preobrazhensky, Yu. A. Sobolev

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Abstract

The purpose of research was to analyze the effectiveness of additional pulmonary artery denervation (PADN) procedure in patients with mitral valve diseases complicated by atrial fibrillation and pulmonary hypertension, and to identify predictors of low efficiency of the proposed method.Material and methods. During the research the analysis of surgical treatment of 140 patients with mitral valve diseases complicated by high pulmonary hypertension (more than 40 mm Hg) and atrial fibrillation was carried out.Conclusions. Integrated surgical approach in the treatment of patients with mitral valve defects, atrial fibrillation and pulmonaryhypertension, implying not only the correction of mitral valve diseases and arrhythmias, but also surgical treatment of pulmonary hypertension can improve the contractility of the left ventricle by 14%, the remodeling of the left ventricle cavity by ESD by 25%, of the right ventricle by 13%, the left atrium by 24%, the right atrium by 21%, and also allows to eliminate pulmonary hypertension by 28% compared with the control group (p <0.05). Additional PADN procedure in patients with mitral valve diseases, complicated by atrial fibrillation and pulmonary hypertension contributes to a decrease tricuspid regurgitation - by 29.5%, an increase in the efficiency of the Maze IV procedure - by 18% and, ultimately, a decrease in clinical manifestations of chronic heart failure by 18% (p<0.05). Predictors of low efficiency of PADN procedure in patients with mitral valve diseases complicated by atrial fibrillation and pulmonary hypertension are the presence of infectious endocarditis, EUROSCORE > 6 points, LV EDD>6.1 cm, LV ESD >4.5 cm, LV EDV>186.9 ml, LV ESV>97.3 ml, LV EF <53.2%, RV ESD>3.8 cm, (p<0.05).

Keywords

вторичная легочная гипертензия, абляция легочного ствола, денервация ганглионарных сплетений, митральный порок, фибрилляция предсердий, процедура (PAND), secondary pulmonary hypertension, pulmonary trunk ablation, ganglion plexus denervation, mitral valve diseases, atrial fibrillation, PADN procedure

About the Authors

N. A. Trofimov

БУ Чувашской Республики «Республиканский кардиологический диспансер» Минздрава Чувашии; ГАУ ДПО «Институт усовершенствования врачей» Минздрава Чувашии; ФГБУ «Федеральный центр травматологии, ортопедии и эндопротезирования» Минздрава России; ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России
Россия

A. P. Medvedev

ФГБОУ ВО «Приволжский исследовательский медицинский университет» Минздрава России
Россия

V. E. Babokin

ФГБОУ ВО «Башкирский государственный медицинский университет» Минздрава России
Россия

I. P. Efimova