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

Abstract

Objective Investigate the influence of the sympathetic denervation of the pulmonary trunk and the orifices of thepulmonary arteries on the degree of pulmonary hypertension (PH) and outcomes of the surgicaltreatment 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 highPH - pulmonary artery systolic pressure (PASP) gradient more than 40 mm Hg. The group of interestincluded 51 patients (46 patients with severe mitral stenosis and five patients with grade 4 mitralvalve regurgitation). All patients underwent mitral valve correction (47 valve replacement surgeriesand 4 valve-sparing interventions), biatrial Maze IV procedure, and additionally, denervation of thepulmonary trunk and the orifices of the pulmonary arteries. The control group included 89 patientsdiagnosed with mitral valve defect, AF, and PH with PASP > 40 mm Hg. However, unlike in patientsof interest, denervation of the pulmonary arteries was not performed.Results Circular radiofrequency denervation of the pulmonary trunk and the orifices of the pulmonaryarteries 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 patientswith mitral valve defects, complicated AF, and high PH.Conclusion This technique must be studied further involving a more significant number of patients, analyzinglong-term results, and using this technique in patients with non-valvular causes of secondary PH.