Circulatory pulmonary artery denervation in patients with severe pulmonary hypertension undergoing combined mitral valve surgery and procedure Maze IV
Main Article Content
Abstract
Background: The aim of this study was to evaluate the impact of sympathetic denervation of the pulmonary trunk and main pulmonary arteries on outcomes of surgical treatment in patients with mitral valve dysfunction, complicated by atrial fibrillation (AF) and severe Pulmonary Hypertension (PH).
Method: Between September 2013 and July 2019, 140 patients with mitral valve dysfunction, concomitant AF and severe PH (mean pulmonary arterial pressure, MPAP, greater than 40 mmHg) who underwent cardiac surgery were analyzed. In the Denervation group, 51 patients underwent mitral valve surgery, biatrial Maze IV procedure and radiofrequency denervation of trunk and both main pulmonary arteries (pulmonary artery denervation, PADN). In the control group, 89 patients underwent the same surgery stages without PADN procedure.
Results: Circular pulmonary artery denervation (PADN) contributes to a significant reduction in secondary PH (p = 0.018), reverse remodeling of the heart chambers, in particular the left atrium (p = 0.01), is an effective and safe method, and improves the results of the Maze IV procedure (p = 0.022) due to the sinus rhythm restoration, in patients with mitral valve dysfunction, complicated by AF and PH.
Conclusions: Circulatory PADN additional to mitral valve surgery and Maze procedure represents a safe and effective treatment method for patients with mitral valve dysfunction, complicated by AF and severe PH. It is necessary to continue the study of this technique involving a larger number of patients, to analyze long-term outcomes and use this technique in patients with non-valvular causes of secondary PH.
Downloads
Article Details
Copyright (c) 2020 Egorovich BV, et al.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Licensing and protecting the author rights is the central aim and core of the publishing business. Peertechz dedicates itself in making it easier for people to share and build upon the work of others while maintaining consistency with the rules of copyright. Peertechz licensing terms are formulated to facilitate reuse of the manuscripts published in journals to take maximum advantage of Open Access publication and for the purpose of disseminating knowledge.
We support 'libre' open access, which defines Open Access in true terms as free of charge online access along with usage rights. The usage rights are granted through the use of specific Creative Commons license.
Peertechz accomplice with- [CC BY 4.0]
Explanation
'CC' stands for Creative Commons license. 'BY' symbolizes that users have provided attribution to the creator that the published manuscripts can be used or shared. This license allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author.
Please take in notification that Creative Commons user licenses are non-revocable. We recommend authors to check if their funding body requires a specific license.
With this license, the authors are allowed that after publishing with Peertechz, they can share their research by posting a free draft copy of their article to any repository or website.
'CC BY' license observance:
|
License Name |
Permission to read and download |
Permission to display in a repository |
Permission to translate |
Commercial uses of manuscript |
|
CC BY 4.0 |
Yes |
Yes |
Yes |
Yes |
The authors please note that Creative Commons license is focused on making creative works available for discovery and reuse. Creative Commons licenses provide an alternative to standard copyrights, allowing authors to specify ways that their works can be used without having to grant permission for each individual request. Others who want to reserve all of their rights under copyright law should not use CC licenses.
Rostagno C (2019) Heart valve disease in elderly. World J Cardiol 11: 71-83. Link: https://bit.ly/36wi1Os
Trofimov NA, Medvedev AP, Babokin VE, Demarin OI, Zhamlikhanov NK, et al. (2016) Surgical Treatment of Complex Arrhythmias in Patients with Non-Ischemic Mitral Insufficiency. Almanac of Clinical Medicine 64-73. Link: https://bit.ly/3cSpvgW
Babokin VE, Rogovskaya YV, Shipulin VM, Batalov RE, Popov SV (2015) Morphology of electrophysiological disorders of myocardium in postinfarction aneurysm and ventricular tachycardia. Russian Journal of Cardiology 11: 18-22. Link: https://bit.ly/3edm3xA
Zheleznev SI, Demidov DP, Afanasiev AV, Nazarov VM, Demin II, et al. (2016) Radiofrequency Denervation of Pulmonary Artery in Surgery of Dysplastic Mitral Valve Defects with Severe Pulmonary Hypertension. Russian Journal of Cardiology 70-72. Link: https://bit.ly/2ZxAFUu
Guazzi M, Vitelli A, Labate V, Arena R (2012) Treatment for pulmonary hypertension of left heart disease. Curr Treat Options Cardiovasc Med 14: 319-327. Link: https://bit.ly/3d1A4OQ
Chen SL, Zhang FF, Xu J, Xie DJ, Zhou L, et al. (2013) Pulmonary artery denervation to treat pulmonary arterial hypertension: the single-center, prospective, first-in-man PADN-1 study (first-in-man pulmonary artery denervation for treatment of pulmonary artery hypertension). J Am Coll Cardiol 62: 1092-1100. Link: https://bit.ly/3c0zNKG
Briongos Figuero S, Moya Mur JL, Garcia-Lledo A, Centella T, Salido L, et al. (2016) Predictors of persistent pulmonary hypertension after mitral valve replacement. Heart Vessels 31: 1091-1099. Link: https://bit.ly/3bWx44T
Bogachev-Prokofiev AV, Zheleznev SI, Afanasyev AV, Fomenko MS, Demidov DP, et al. (2019) Denervation of pulmonary artery during mitral valve surgery in patients with high pulmonary hypertension. Pulmonary Artery Denervation in Patients with Mitral Valve Defects 19: 19-25. Link: https://bit.ly/3galS8h
Trofimov NA, Medvedev AP, Dragunov AG, Nikolsky AV, Mizurova TN, et al. (2017) Method of surgical treatment of secondary pulmonary hypertension in the case of patients having surgical correction of mitral valve pathology. Medical almanac 33-37. Link:
Lam CS, Borlaug BA, Kane GC, Enders FT, Rodeheffer RJ, et al. (2009) Age-associated increases in pulmonary artery systolic pressure in the general population. Circulation 119: 2663-2670. Link: https://bit.ly/2WXdMrK
Zoni-Berisso M, Lercari F, Carazza T, Domenicucci S (2014) Epidemiology of atrial fibrillation: European perspective. Clin Epidemiol 6: 213-220. Link: https://bit.ly/3ecWfSg
Breithardt G, Baumgartner H (2015) Valvular heart disease among non-valvular atrial fibrillation: a misnomer, in search of a new term. Eur Heart J 36: 1794-1797. Link: https://bit.ly/2Zrpf4N
Kirchhof P, Ammentorp B, Darius H, De Caterina R, Le Heuzey JY, et al. (2014) Management of atrial fibrillation in seven European countries after the publication of the 2010 ESC Guidelines on atrial fibrillation: primary results of the PREvention oF thromboemolic events--European Registry in Atrial Fibrillation (PREFER in AF). Europace 16: 6-14. Link: https://bit.ly/2ZtILgR
Kim JS, Lee SA, Park JB, Chee HK, Chung JW (2014) Preoperative risk factor analysis of postoperative stroke after Cox-maze procedure with mitral valve repair. BMC Cardiovasc Disord 14: 116. Link: https://bit.ly/3geGpsc
Cox JL (2003) Atrial fibrillation I: a new classification system. J Thorac Cardiovasc Surg 126: 1686-1692. Link: https://bit.ly/3cX2tFN
Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, et al. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur J Cardiothorac Surg 37: 2893-2962. Link: https://bit.ly/2yrWSZ7
Babokin V, Trofimov N (2020) Prevention of atrial fibrillation recurrence after the Maze IV procedure. Ann Thorac Surg 109: 1624-1625. Link: https://bit.ly/36p33JN
Gillinov AM, Gelijns AC, Parides MK, DeRose JJ, Moskowitz AJ, et al. (2015) Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med 372: 1399-1409. Link: https://bit.ly/2ZuqIqV
Hurdman J, Condliffe R, Elliot CA, Davies C, Hill C, et al. (2012) ASPIRE registry: assessing the Spectrum of Pulmonary hypertension Identified at a REferral centre. Eur Respir J 39: 945-955. Link: https://bit.ly/3gkdyTA
Bogunetsky AA, Ussov VY, Babokin VE (2014) Cardiovascular magnetic resonance with contrast agent: prognostic role in determining arrhytmogenic focus. Bulletin of Siberian Medicine 13: 98-102.
Rubin LJ (1997) Primary pulmonary hypertension. N Engl J Med 336: 111-117. Link: https://bit.ly/3cWua1B
Galie N, Manes A, Negro L, Palazzini M, Bacchi-Reggiani ML, et al. (2009) A meta-analysis of randomized controlled trials in pulmonary arterial hypertension. Eur Heart J 30: 394-403. Link: https://bit.ly/2A7Jc5N
Hoeper MM, Barbera JA, Channick RN, Hassoun PM, Lang IM, et al. (2009) Diagnosis, assessment, and treatment of non-pulmonary arterial hypertension pulmonary hypertension. J Am Coll Cardiol 54: 85-96. Link: https://bit.ly/3cWuhu3
Osorio J, Russek M (1962) Reflex changes on the pulmonary and systemic pressures elicited by stimulation of baroreceptors in the pulmonary artery. Circ Res 10: 664-667. Link: https://bit.ly/3gfHWOO
Baylen BG, Emmanouilides GC, Juratsch CE, Yoshida Y, French WJ, et al. (1980) Main pulmonary artery distention: A potential mechanism for acute pulmonary hypertension in the human newborn infant. J Pediatr 96: 540-544. Link: https://bit.ly/2WYMSQB
Juratsch CE, Jengo JA, Castagna J, Laks MM (1980) Experimental pulmonary hypertension produced by surgical and chemical denervation of the pulmonary vasculature. Chest 77: 525-530. Link: https://bit.ly/3edoj8d