Novosti
Khirurgii

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Year 2016 Vol. 24 No 3

GENERAL & SPECIAL SURGERY

L.A. BOCKERIA, O.L. BOCKERIA, V.A. SHVARTZ, M.K. SANAKOEV, A.Y. ISPIRYAN, Z.F. FATULAEV, T.G. LE

THE IMMEDIATE RESULTS OF SIMULTANEOUS SURGICAL CORRECTION OF COMPLEX HEART DISEASE WITH CONCOMITANT ATRIAL FIBRILLATION

FSBE "Scientific Center of Cardiovascular Surgery named after A.N. Bakulev"
Ministry of Health of the Russian Federation, Moscow,
The Russian Federation

Objectives. To assess the results of simultaneous surgical correction of the complex surgical pathology of the heart and atrial fibrillation.
Methods. A retrospective analysis for the period 2009-2014 of the patients with simultaneous surgical correction of the atrial fibrillation (AF) and complex heart disease was carried out. The study enrolled 37 patients, aging 52 (49; 58), 51% of males, 49% of females. All patients with chronic heart failure were classified in NYHA class III-IV. The duration of AF composed 36 (24; 60) months. AF types were the following: a persistent one in 75,5%, a paroxysmal one – in 24,5%. The calculated risks comprised: EuroScore II – 4,1 (2,8; 5,9), the risk of in-hospital mortality and total mortality risk by Ambler – 5,5 (3; 7,3) and 8 (6; 9), respectively.
Results. The average number of simultaneous procedures on the heart performed per patient was 4 (4, 4), min – 3, max – 5. In 100% cases the aortic and mitral valve correction, and maze IIIB procedure were performed simultaneously. Coronary artery bypass grafting (CABG) was carried out in 19% of cases and the tricuspid valve repair was performed in 67%. The total duration of operations amounted 6,68±1,53 hours, time of cardiopulmonary bypass (CPB) – 212 (183; 238) min., aortic clamp – 139 (120; 157) min. Hospital mortality rate was 5,4%. In the early incisional period the main non-lethal complications were: acute heart failure, respiratory and renal insufficiency, and transient neurological disorders.
Conclusion. The literature review of such complicated types of cardiac surgical operations is quite meager that associated with the severity of patients and refusal of surgical correction. However, a qualified team of specialists possessing a highly professional approach to this category of patients is able to ensure the success of the surgical treatment of complex heart disease combined with simultaneous performing of 4 or more procedures. In the suggested series of observations, the hospital mortality correlated with the calculated one (5,4%) which is a quite good result in this patient category.

Keywords: atrial fibrillation, multivalve heart diseases, NYHA classification, coronary artery bypass surgery, simultaneous operations, early incisional period, hospital mortality rate

p. 227-233 of the original issue
References
  1. Weimar T, Gaynor SL, Seubert DY, Damiano RJ Jr, Doll N. Performing the left atrial maze ablation pattern without atriotomy. Ann Thorac Surg. 2016 Feb;101(2):777-9. doi: 10.1016/j.athoracsur.2015.05.137.
  2. Lawrance CP, Henn MC, Damiano RJ Jr. Concomitant Cox-Maze IV techniques during mitral valve surgery. Ann Cardiothorac Surg. 2015 Sep; 4(5): 483-86. doi: 10.3978/j.issn.2225-319X.2014.12.06.
  3. Dobrotin SS, Zemskova EN, Chiginev VA, Medvedev AP, Pichugin VV, Gamzaev AB. Khirurgicheskaia taktika pri korrektsii mnogoklapannykh porokov serdtsa [Surgical tactics for the correction of multi-valve heart defects]. Patologiia Krovoobrashcheniia i Kardiokhirurgiia. 2006;(4):21-25.
  4. Novikov VK, Bondarenko BB, Prokopchuk EF. Rezul'taty khirurgicheskogo lecheniia mnogoklapannykh porokov serdtsa u bol'nykh s vysokoi stepen'iu riska [Results of surgical treatment of multi-valve heart defects in patients with a high risk]. Patologiia Krovoobrashcheniia i Kardiokhirurgiia. 1998;(1):31-33.
  5. Dzhoshibaev SD, Bolatbekov BA. Odnomomentnoe primenenie khirurgicheskoi radiochastotnoi ablatsii i atrioplastiki levogo predserdiia pri korrektsiiakh mitral'nogo poroka serdtsa [Simultaneous use of surgical radiofrequency ablation of the left atrium and atrioplastiki the correction of mitral heart defect]. Vestn RAMN. 2015; 70(3): 279-85. doi: 10.15690/vramn.v70i3.1323.
  6. Ad N, Holmes SD, Pritchard G, Shuman DJ. Association of operative risk with the outcome of concomitant Cox Maze procedure: a comparison of results across risk groups. J Thorac Cardiovasc Surg. 2014 Dec;148(6):3027-33. doi: 10.1016/j.jtcvs.2014.05.039.
  7. Weimar T, Gaynor SL, Seubert DY, Damiano RJ Jr, Doll N. Performing the Left Atrial Maze Ablation Pattern Without Atriotomy. Ann Thorac Surg. 2016 Feb;101(2):777-79. doi: 10.1016/j.athoracsur.2015.05.137.
  8. Cox JL. Surgical ablation for atrial fibrillation. N Engl J Med. 2015 Jul 30;373:483-84. doi: 10.1056/NEJMc1506893.
  9. Bokeriia LA, Sergeev AV. Predserdnye aritmii posle khirurgicheskogo lecheniia fibrilliatsii predserdii (obzor literatury) [Atrial fibrillation after surgical treatment of atrial fibrillation (Review of the literature]. Annaly Aritmologii. 2014; 11(2): 87-97. doi: 10.15275/annaritmol.2014.2.3.
  10. Bokeriia LA, Shengeliia LD. Lechenie fibrilliatsii predserdii. Ch II. Segodniashnie realii i zavtrashnie perspektivy [Treatment of atrial fibrillation. P II. Today's realities and tomorrow's prospects]. Annaly Aritmologii. 2014;11(2):76-86. doi: 10.15275/annaritmol.2014.2.2.
  11. Gillinov AM, Gelijns AC, Parides MK, DeRose JJ Jr, Moskowitz AJ, Voisine P, et al. Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med. 2015 9; 372(15): 1399-409. doi: 10.1056/NEJMoa1500528.
  12. Gillinov AM, Bhavani S, Blackstone EH, Rajeswaran J, Svensson LG, Navia JL, et al. Surgery for permanent atrial fibrillation: impact of patient factors and lesion set. Ann Thorac Surg. 2006 Aug;82(2):502-13; discussion 513-14.
  13. Prasad SM, Maniar HS, Camillo CJ, Schuessler RB, Boineau JP, Sundt TM 3rd, et al. The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures. J Thorac Cardiovasc Surg. 2003 Dec;126(6):1822-28.
  14. Gaynor SL, Schuessler RB, Bailey MS, Ishii Y, Boineau JP, Gleva MJ, et al. Surgical treatment of atrial fibrillation: predictors of late recurrence. J Thorac Cardiovasc Surg. 2005 Jan;129(1):104-11.
Address for correspondence:
Russian Federation,
121552, Moscow,
Rublevskoe shosse, d. 135,
FGBU "Nauchnyiy tsentr
serdechno-sosudistoy khirurgii im. A.N. Bakuleva",
otdelenie khirurgicheskogo lecheniya interaktivnoy patologii,
tel. office: 79032619292, shvartz.va@ya.ru
Shvartz Vladimir Aleksandrovich
Information about the authors:
Bockeria L.A. MD, professor, an Academician of RAMS and RAS, director of FSBE "SC CVS named after Bakulev", MH RF, cardiovascular surgeon.
Bockeria O.L. MD, professor, a chief researcher, Deputy Head of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Shvartz V.A. PhD, junior researcher, cardiologist of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Sanakoev M.K. PhD, a junior researcher, cardiovascular surgeon of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Ispiryan A.Y. An junior researcher, cardiologist of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Fatulaev Z.F. PhD, a researcher, cardiovascular surgeon of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
Le T.G. An junior researcher, cardiologist of the department of surgical treatment of interactive pathology of FSBE "SC CVS named after Bakulev".
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