EXPERIENCE IN SURGICAL TREATMENT OF ATRIAL FIBRILLATION IN PATIENTS WITH MITRAL VALVE DEFECTS AND HIGH-GRADE PULMONARY HYPERTENSION
The purpose of the study is: to analyze the results of surgical treatment of patients with mitral defects complicated by atrial fibrillation (AF) and high pulmonary hypertension (PH), to identify the main predictors of AF recurrence. Material and methods. The results of surgical treatment of 151 patients with mitral defects, concomitant AF and high PH (systolic pressure in the pulmonary artery (SPPA) of more than 40 mm Hg) were analyzed. In the conditions of cardiopulmonary bypass (CB), correction of valvular pathology (control group n=62) and surgical treatment of mitral defect together with operative AF treatment (study group n=89) were carried out by performing the Maze IV procedure using a radiofrequency destructor under the transmurality control in the period from 2015 to 2017. The results of the research work demonstrate the effectiveness of the Maze IV procedure at the level of 66% in 2 years in patients with mitral malformation, AF and high PH. At this, there was no significant influence of surgical AF treatment on the reduction of PH in the postoperative period. High PH significantly reduces the effectiveness of surgical AF treatment (p = 0.041) and remains at a high level after isolated correction of valvular pathology, which requires an additional specific treatment of this pathology. Predictors of AF recurrence after the Maze IV procedure and valvular correction of the mitral defect are initially high PH (SPPA of more than 60 mmHg) and the duration of arrhythmic history of more than 3 years (px 2<0.001). Conclusion. The Maze IV procedure is an effective and safe method of surgical AF correction in patients with mitral valve defects and high PH. However, it is necessary to take into account the identified predictors when planning such patients for surgical correction.