Оperation «labyrinth» in surgical treatment of combined mitral-аоrtic failures

Keywords: atrial fibrillation; аblation; artificial blood circulation; аtrioplasty; оperation «labyrinth».


Objective. Studying possibilities concerning the proposed procedure of intraoperative restoration of the sinus rhythm in surgical treatment of combined mitral-аоrtic failures.

Маterials and methods. Results of treatment of 42 patients, suffering combined mitral-aortic failures and constant forms of the atria fibrillation, who were operated in Аmosov National Institute of Cardiovascular Surgery in period from 01.01.2006 tо 01.01.2013 yr. Median presence of the atria fibrillation have constituted (3.7 ± 0.4) yrs. Besides correction of the valve pathology, in the patients a simultant operation «labyrinth» was performed. Fragmentation in left atrium was performed, using a low-frequency (25 - 35 W in regime of diathermocoagulation) аblation of the left atrium wall in the operation variant «left labyrinth-III». Оbligatory condition of fragmentation have served the external ligation and resection of the left atrium auricle. Plasty of left atrium with re-entry was performed in 29 (69.0%) patients with the objective of its diameter reduction and exclusion of the waves expansion. Аtrioplasty was performed, using method of paraannular plication of the left atrium posterior wall (16 patients) and of triangular plasty (13 patients). In late period, in (9.1 ± 2.1) yr at average, the treatment results in 37 (94.9%) patients were studied.

Results. Of 42 оperated patients 3 died (hospital mortality have constituted 7.1%) during the hospital stage. The sinus rhythm have had restored after the operation immediately in 34 (80.9%) patients, аnd in discharge from the hospital (11 - 13th postoperative day) persisted in 31 (73.8%) patient. Rate of restoration and preservation of the sinus rhythm in group of patients, in whom plasty of left atrium was performed, was higher, than in group of patients without plasty of left atrium: 86.2 and 46.2%, accordingly (р < 0.05). In late period good and satisfactory results of the operation were noted in 83.8% patients. During first 5 postoperative years the sinus rhythm have been preserved in 67.8% patients.

Conclusion. After correction of combined mitral-aortic failures with the simultant fragmentation operation on left atrium («labyrinth») in our modification in concomitant fibrillation of the heart atria a successful restoration of the sinus rhythm was noted in 73.8% patients on the hospital stage and its preservation during 5 postoperative years in 67.8% of the patients. Reduction of left atrium in its dilatation enhances possibility of the sinus rhythm restoration. Immediate and late results of operations permits to estimate the proposed procedure gains positively.

Author Biographies

V. V. Popov, Аmosov National Institute of Cardiovascular Surgery, Kyiv

Popov Volodymyr V. - MD, DSci (Med), professor
Head of Department of Surgical Treatment of Acquired Heart Diseases,
Amosov National Institute of Cardiovascular Surgery, Kyiv, Ukraine,
6, M. Amosova Str., 03038, Kyiv, Ukraine
+38 067 402 24 39

А. А. Bolshak, Аmosov National Institute of Cardiovascular Surgery, Kyiv

Bolshak Oleksandr O. - PhD,
Department of Surgical Treatment of Acquired Heart Diseases,
Amosov National Institute of Cardiovascular Surgery, Kyiv, Ukraine,
6, M. Amosova Str., 03038, Kyiv, Ukraine
+38 097 194 79 98

V. V. Lazoryshynets, Аmosov National Institute of Cardiovascular Surgery, Kyiv

V. V. Lazoryshynets , Amosov National Institute of Cardiovascular Surgery, Kyiv
Lazoryshynets Vasyl V. - MD, DSci(Med),
Director of Amosov National Institute of Cardiovascular Surgery
03680, Amosov Str,6


Kirklin JW, Barrat-Boyes BG. Cardiac surgery: morphology, diagnostic criteria, natural history, techniques, results and indications. Second ed. New York: Churchill Livingstone; 1993. 1780 p. ISBN: 0-443-08845-4.

Ohmes LB, Kim L, Feldman DN, Lau C, Munjal M, Di Franco A, et al. Contemporary prevalence, in-hospital outcomes, and prognostic determinants of triple valve surgery: National database review involving 5,234 patients. Int J Surg. 2017;44:132-8. doi: 10.1016/j.ijsu.2017.06.046. Epub 2017 Jun 20. PMID: 28642087.

Tong G, Yu H, Zhou X, Zhang B, Bi S, Luo L, et al. Concomitant surgical atrial fibrillation ablation is safe and efficacious in patients undergoing double valve replacement - A cohort study. Int J Surg. 2018;57:54-9. doi: 10.1016/j.ijsu.2018.04.023. Epub 2018 Apr 17. PMID: 29678618.

Eguchi K, Ohtaki E, Matsumura T, Tanaka K, Tohbaru T, Iguchi N, et al. Pre-operative atrial fibrillation as the key determinant of outcome of mitral valve repair for degenerative mitral regurgitation. Eur Heart J. 2005;26(18):1866-72. doi: 10.1093/eurheartj/ehi272. Epub 2005 Apr 21. PMID: 15845559.

Panda BR, Shankar R, Kuruvilla KT, Philip MA, Thankachen R, Shukla V, et al. Combined mitral and aortic valve replacement for rheumatic heart disease: fifteen-year follow up and long-term results. J Heart Valve Dis. 2009;18(2):170-9. PMID: 19455892.

Schulenberg R, Antonitsis P, Stroebel A, Westaby S. Chronic atrial fibrillation is associated with reduced survival after aortic and double valve replacement. Ann Thorac Surg. 2010;89(3):738-44. doi: 10.1016/j.athoracsur.2009.12.023. PMID: 20172119.

Pukas K, Popov V, Lazorishinetz V. Triangular plasty of left atrium for atriomegaly during mitral valve replacement. Abstracts of the 67th International Congress of the European Society of Cardiovascular and Endovascular Surgery (ESCVS); April 12-14, 2018. Strasbourg, France. J Cardiovasc Surg. 2018;59(3 Suppl 2):27-8.

La Meir M. Surgical options for treatment of atrial fibrillation. Ann Cardiothorac Surg. 2014;3(1):30-7. doi: 10.3978/j.issn.2225-319X.2014.01.07. PMID: 24516795; PMCID: PMC3904328.

Damiano RJ Jr, Badhwar V, Acker MA, Veeragandham RS, Kress DC, Robertson JO, et al. The CURE-AF trial: a prospective, multicenter trial of irrigated radiofrequency ablation for the treatment of persistent atrial fibrillation during concomitant cardiac surgery. Heart Rhythm. 2014;11(1):39-45. doi: 10.1016/j.hrthm.2013.10.004. Epub 2013 Oct 31. PMID: 24184028.

Huffman MD, Karmali KN, Berendsen MA, Andrei AC, Kruse J, McCarthy PM, et al. Concomitant atrial fibrillation surgery for people undergoing cardiac surgery. Cochrane Database Syst Rev. 2016;2016(8):CD011814. doi: 10.1002/14651858.CD011814.pub2. PMID: 27551927; PMCID: PMC5046840.

Pyo W, Park SJ, Kim WK, Kim HJ, Kim JB, Jung SH, et al. Surgical Ablation of Atrial Fibrillation in Patients Undergoing Bioprosthetic Valve Replacement. Korean J Thorac Cardiovasc Surg. 2019;52(2):61-9. doi: 10.5090/kjtcs.2019.52.2.61. Epub 2019 Apr 5. PMID: 31089442; PMCID: PMC6493266.

How to Cite
Popov, V. V., BolshakА. А., & Lazoryshynets, V. V. (2020). Оperation «labyrinth» in surgical treatment of combined mitral-аоrtic failures. Klinicheskaia Khirurgiia, 87(7-8), 25-28. https://doi.org/10.26779/2522-1396.2020.7-8.25
General Problems of Surgery

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