The immediate results of simultaneous surgical correction of complex heart disease with concomitant atrial fibrillation

Abstract

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 inhospital 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.