ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ СЛОЖНЫХ НАРУШЕНИЙ РИТМА У ПАЦИЕНТОВ С МИТРАЛЬНОЙ НЕДОСТАТОЧНОСТЬЮ НЕИШЕМИЧЕСКОЙ ЭТИОЛОГИИ

Статья в Elpub

Альманах клинической медицины. 2015; : 64-73

ХИРУРГИЧЕСКОЕ ЛЕЧЕНИЕ СЛОЖНЫХ НАРУШЕНИЙ РИТМА У ПАЦИЕНТОВ С МИТРАЛЬНОЙ НЕДОСТАТОЧНОСТЬЮ НЕИШЕМИЧЕСКОЙ ЭТИОЛОГИИ

Трофимов Н. А., Медведев А. П., Бабокин В. Е., Демарин О. И., Жамлиханов Н. Х., Драгунов А. Г., Гартфельдер М. В., Николаева О. В., Драгунова М. В., Елдырев А. Ю., Владимирова Т. Н.

https://doi.org/10.18786/2072-0505-2015-38-64-73

Аннотация

Цель – повышение эффективности оперативного лечения пациентов с митральной недостаточностью неишемической этиологии и фибрилляцией предсердий.

Материал и методы. В исследование вошли 64 пациента с митральной недостаточностью дегенеративного генеза, осложненной фибрилляцией предсердий, проходившие хирургическое лечение с 2011 по 2014 г. Оперативное лечение заключалось в хирургической коррекции митральной недостаточности при помощи реконструкции митрального клапана (1-я группа, n = 33) и протезирования механическим протезом (2-я группа, n = 31), а также в проведении процедуры левопредсердной Maze IV в модификации “box lesion” с использованием биполярного деструктора AtriCure в обеих

группах.

Результаты. Послеоперационных летальных исходов не зарегистрировано. У всех прооперированных пациентов наблюдалось уменьшение размеров полостей сердца, легочной гипертензии, улучшение систолической функции левого желудочка по данным контрольной трансторакальной эхокардиографии. Сохранность синусового ритма при наблюдении до 14 месяцев отмечалась у 56 (86%) пациентов, у 9 (14%) был рецидив фибрилляции предсердий, резистентный к медикаментозной и электрической кардиоверсии. В группе пациентов с клапаносохраняющей коррекцией митральной недостаточности и операцией левопредсердной Maze IV получены наилучшие результаты: увеличилась сократительная способность левого желудочка (7,86%), уменьшились размеры полостей сердца (конечно-диастолический размер – 11,05%, конечно-систолический размер – 15,15%, правое предсердие – 15,19%), особенно левого предсердия (19,03%), снизилась легочная гипертензия (27,75%), а также значительно повысилось качество жизни (7 баллов) по данным Миннесотского опросника качества жизни больных хронической сердечной недостаточностью (MLHFQ).

Заключение. Пластическая коррекция митральной недостаточности с фибрилляцией предсердий совместно с процедурой Maze IV дает лучшие показатели увеличения сократительной способности левого желудочка и сокращения полостей сердца по сравнению с протезированием митрального клапана механическим протезом совместно с процедурой Maze IV.

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Almanac of Clinical Medicine. 2015; : 64-73

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

Trofimov N. A., Medvedev A. P., Babokin V. E., Demarin O. I., Zhamlikhanov N. Kh., Dragunov A. G., Gartfelder M. V., Nikolaeva O. V., Dragunova M. V., Eldyrev A. Yu., Vladimirova T. N.

https://doi.org/10.18786/2072-0505-2015-38-64-73

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.

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