IMMEDIATE AND REMOTE RESULTS OF THE LEFT-ATRIAL “LABYRINTH” SURGERY IN PATIENTS WITH CORONARY HEART DISEASE AND MITRAL VALVE PATHOLOGY

Aim. To assess the medium-term results of the left-atrial modification of the surgery “labyrinth-3” in 100 patients with associated pathology of the mitral valve (MV). Materials and methods. One hundred patients (mean age 62,7 ± 4,5 years) with MV pathology, protractedly persisting form of atrial fibrillation (AF) (during 18±5,1 months) ( n = 81), persisting form of AF ( n = 15) and paroxysmal form of AF ( n = 4) were examined. All patients were operated for associated MV pathology over the period from 2010 to 2012. Etiology of mitral valve damage was estimated: degenerative damages - in 62 patients, ischemic mitral insufficiency - in 30 patients, rheumatic heart disease - in 4 patients, idiopathic annulectasia and mitral insufficiency - in 4 patients. During the pre-and postoperative periods, the general clinical and echocardiographic data, the results of Holter monitoring and coronography were assessed. Results. All patients underwent the left-atrial modification of the surgery “labyrinth-3” with correction of mitral valve pathology. Thirty one patients underwent intervention associated with coronary artery bypass grafting, 33 patients - tricuspidal insufficiency correction. Hospital lethality was 3 % - 3 patients died from multiple organ failure. During the first month ( n = 96), sinus rhythm was observed in 85 (89 %) patients including mechanical systole of the left atrium - in 18 %. Eight patients (8,2 %) had atrial fibrillation, 3 (2,8 %) patients needed introduction of electrical stimulator in connection with weakness of sinus node. Six months after the surgery ( n = 71), sinus rhythm was registered in 59 (83 %) patients, mechanical systole of LA - in 55 % of them; one year after the surgery ( n = 39), sinus rhythm was detected in 31 (81 %) patients, mechanical systole of LA - in 48 %. During one year, a two-chamber electrical stimulator was introduced to 4 patients more, in connection with atrioventricular blockade. During 12 months, 80 % of patients were free from atrial fibrillation, 98,7 % were free from acute stroke. Conclusions. The procedure of the left-atrial “labyrinth” associated with correction of MV pathology does not elevate lethality and is efficient in 80 % of patients. Mechanical function frequency of LA in patients with sinus rhythm is being increased during a year in half of patients. Cumulative freedom from stroke is 98,7 % a year.

Atrial fibrillation, “labyrinth” surgery, mitral insufficiency