ANALYSIS OF LONG-TERM RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH MITRAL HEART DEFECTS AND ATRIOMEGALIA
DOI:
https://doi.org/10.11603/2414-4533.2025.3.15668Keywords:
acquired heart defects, left atrial appendage plastic surgery, left atrial appendage resection, mitral valve prosthesis, long-term resultsAbstract
The aim of the work: to study the risks of fatal cases in the long term after surgical treatment of patients with mitral heart defects and atriomegaly.
Materials and Methods. The study included 671 patients with mitral heart disease and left atriummegaly. Atriomegaly was considered as an increase in the linear size of the left atrium by more than 6.0 cm and its volume by more than 59.8 cm3/m2 according to echocardiography. All patients in the sample underwent surgical treatment of mitral valve disease at the Department of Surgical Treatment of Acquired Heart Defects of the State Institution "Amosov National Institute of Cardio-Vascular Surgery affiliated to National Academy of Medical Sciences of Ukraine". The study design was built depending on the surgical technique used and the volume of surgical intervention, according to which the patients in the sample were divided into two groups: the main and comparison groups. The main group (n=271) included patients who underwent mitral valve prosthesis and left atrial appendage resection. In patients in the comparison group (n=400), only surgical correction of mitral valve disease was performed. The material for analysis was data from primary medical records: medical history, operation protocols, and clinical and instrumental examination data. All patients of the study gave informed voluntary consent.
Results. In this study, hospital mortality was 2.2 % among all cases, in patients of the main group it was 1.8 %, and in the comparison group – 2.5 % (p>0.05). It was established that the frequency of fatal cases in patients of the sample in the long term was 5.8 %, in patients of the main group – 4.5 %, and in the comparison group – 6.7 % (p=0.015; χ2=5.93). It was found that patients who underwent left atrial plasty for atrial atrium megaly with resection of its appendage, in addition to surgical correction of mitral valve disease, had a reduced risk of mortality both in the hospital period (OR=1.35; 95 % CI: 0.45–4.0, RR=1.34; 95 % CI: 0.46–3.89, p>0.05) and in the period of observation of long-term results (OR=1.50; 95 % CI: 0.74–3.02, RR=1.46; 95 % CI: 0.75–2.85, p>0.05).
Conclusions. As a result of studying the long-term results of surgical treatment of the mitral valve in patients with atriomegaly, it was found that patients who underwent its correction and left atrial appendage resection with resection of its appendage have a lower frequency of hospital mortality and a 1.35-fold lower risk of its occurrence (OR=1.35; RR=1.34; p>0.05). Patients who underwent correction of mitral heart defect and left atrial appendage resection have a significantly lower frequency of fatal events in the long term after surgery (p=0.015; χ2=5.93) and a 1.5-fold lower risk of their occurrence, compared with patients who underwent only surgical correction of mitral heart defect (OR=1.50; RR=1.46; p>0.05).
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