Possibilities and prospects of surgical treatment of atrial fibrillation

Vaskovskiy, V.A.; Serguladze, S.Yu.

doi:10.15275/annaritmol.2016.2.1

Cited by 5 publications

(3 citation statements)

References 2 publications

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“…В связи с этим коррекция клапанного аппарата является первоочередной задачей успешного лечения при ФП [2,8]. Однако даже адекватная коррекция патологии митрального клапана у больных с дооперационной ФП способствует восстановлению синусового ритма лишь у 8,5-20 % больных, что требует дополнительного хирургического вмешательства [9][10][11].…”

Section: автор для перепискиunclassified

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

et al. 2020

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Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of the pulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgical treatment of atrial fibrillation (AF) in patients with mitral valve defects, complicated AF, and high PH.Material and methods We analyzed the surgical treatment of 140 patients with mitral valve defect, concomitant AF, and high PH – pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interest included 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitral valve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeries and 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of the pulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patients diagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patients of interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonary arteries using a clamp-destructor is an effective and safe method, significantly reduces secondary PH (p=0.018), promotes reverse remodeling of the heart chambers, left atrium in particular (p=0.01), and improves outcomes of the Maze IV procedure (p=0.022) by restoring sinus rhythm in patients with mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzing long-term results, and using this technique in patients with non-valvular causes of secondary PH.

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Section: автор для перепискиunclassified

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

et al. 2020

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“…Atrial fibrillation is the most frequent arrhythmological complication in patients with valvular heart disease observed in 30-50% of cases. Concomitant AF reduces the effectiveness of surgery and affects the postoperative course in this category of patients: it significantly increases the risk of thromboembolic complications, promotes the progression of heart failure and, as a result, increases overall mortality [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Histological Justification for the Need of Radiofrequency Ablation of Pulmonary Arteries in Patients with High-Grade Secondary Pulmonary Hypertension

Trofimov¹,

Rodionov²,

Egorov³

et al. 2021

Sovrem Tehnol Med

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The aim of the study was to perform a histological assessment of the effectiveness of radiofrequency exposure for circular denervation of the pulmonary artery in patients with secondary high pulmonary hypertension.Materials and Methods. The study was carried out on the autopsy material derived from non-operated patients. Three groups were formed. The experimental group included the material (207 histological samples) from the patients with chronic high pulmonary hypertension arising on the background of mitral heart disease. The samples of this group were exposed to circular radiofrequency ablation. In the comparison group, we used autopsy material (24 samples) obtained from the patients with high pulmonary hypertension. The control group included material (35 samples) from the patients without pulmonary hypertension who died from causes not associated with cardiovascular diseases. The samples of the comparison and control groups were not exposed to radiofrequency.Visual evaluation of the damage to the vascular wall was performed after hematoxylin and eosin staining, according to Van Gieson. Damage to the nerve plexuses was evaluated after their impregnation by silver salts. To assess the degree of damage to the vascular wall on the stained sections, a scoring method of semi-quantitative analysis of the observed pathological processes (fibrinoid necrosis, metachromasia, karyorrhexis, karyolysis, fibrinoid and mucoid swelling, lipid presence) was used. Silver salt impregnation allowed visualizing damage to the reticular fibers, trunks and endings of peripheral nerve fibers.Results. The mean optical density of the ablation group was statistically significantly lower than in the comparison and control groups (p<0.001). The mean specific area of tissue dissociation was higher in the "marginal zones" of the ablated sections, under pronounced mechanical compression in these areas. The difference in the mean areas of the argentophilic samples of the ablation and comparison and control groups was expressed in a lower percentage of argentophilic fibrous structures (p<0.05). At the same time, the highest concentration of argentophilic structures was observed in the comparison group, which points to a bigger content of nerve fiber structures in the patients with high pulmonary hypertension. Conclusion.The results of the histological study demonstrated the feasibility of radiofrequency ablation of the pulmonary arteries in patients with high-grade secondary pulmonary hypertension. Radiofrequency denervation leads to the destruction of the sympathetic ganglia in the adventitial layer of the pulmonary arteries, which are responsible for the spasm of the precapillary bed of the pulmonary circulation, which promotes vasodilation, an increase in the vascular bed, and, as a result, a reduction in pulmonary hypertension.

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“…Yet, the sinus rhythm is restored in only 8.5-20.0% of patients who undergo mitral valve repair. Therefore, additional efforts to treat cardiac arrhythmias are needed [14][15][16].…”

Section: Introductionmentioning

confidence: 99%

Denervation of Pulmonary Arteries in Patients with Mitral Valve Defects Complicated by Atrial Fibrillation and Pulmonary Hypertension

Trofimov¹,

Медведев²,

Nikolsky³

et al. 2019

Sovrem Tehnol Med

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The aim of the study was to evaluate whether sympathetic denervation of the trunk and orifices of pulmonary arteries could reduce pulmonary hypertension and help in managing atrial fibrillation. In addition, we aimed to identify the main predictors of recurrent rhythm disturbances in patients with mitral valve dysfunction complicated by atrial fibrillation and high pulmonary pressure. Materials and Methods. We analyzed the results of surgical treatment of 140 patients with mitral defects complicated by atrial fibrillation and high-grade pulmonary hypertension (more than 40 mm Hg). In the main group of patients (n=51), surgical intervention included the correction of mitral defect, the treatment for atrial fibrillation according to Maze IV, and the radiofrequency denervation of the trunk and orifices of the pulmonary artery in order to correct pulmonary hypertension. In the control group (n=89), patients with similar heart defects underwent the mitral dysfunction repair (Maze IV), but no denervation of the pulmonary trunk or orifices was performed. Results. We found that the circular radiofrequency denervation of the trunk and orifices of the pulmonary arteries effectively reduced pulmonary hypertension in patients with mitral valve defects complicated by atrial fibrillation and high pulmonary pressure. The proposed procedure results in reverse remodeling of the heart cavities, especially the left atrium (p=0.01), a decrease in pulmonary hypertension, and permanent restoration of a sinus rhythm after the Maze IV procedure (p=0.008). The main predictors of recurrent atrial fibrillation in these patients after the combined surgical treatment are arrhythmias lasting over 5 years (p=0.04), initial pulmonary hypertension of more than 60 mm Hg (p=0.028), concomitant severe tricuspid insufficiency (p=0.006) and atherosclerotic lesions in the brachiocephalic and cerebral vessels.

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Possibilities and prospects of surgical treatment of atrial fibrillation

Cited by 5 publications

References 2 publications

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Circular Sympathetic Pulmonary Artery Denervation in Cardiac Surgery Patients With Mitral Valve Defect, Atrial Fibrillation and High Pulmonary Hypertension

Histological Justification for the Need of Radiofrequency Ablation of Pulmonary Arteries in Patients with High-Grade Secondary Pulmonary Hypertension

Denervation of Pulmonary Arteries in Patients with Mitral Valve Defects Complicated by Atrial Fibrillation and Pulmonary Hypertension

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