Enhanced Reverse Cardiac Remodeling After Pulmonary Artery Denervation Combined with Mitral and Maze Surgery

Objectives: the study evaluates the effectiveness of reverse cardiac remodeling in patients after surgical treatment of severe pulmonary hypertension (PH) in patients with mitral valve disease and atrial fibrillation (AF). Methods: the analysis of the surgical treatment of 202 patients with mitral valve disease complicated by PH (more than 40 mmHg) and AF was performed. The surgical intervention consisted in surgical correction of mitral dysfunction (valve replacement or repair) – the group 1 of patients (n = 62). Patients of the second group (n = 89) additionally underwent the Maze IV procedure for concomitant AF using the AtriCure bipolar radiofrequency ablator. Patients of the group 3 (n = 51) underwent a complex surgical intervention consisting of mitral valve surgery, AF correction using Maze IV, circular radiofrequency denervation of the trunk and orifices of the pulmonary arteries (PA) (Pulmonary Artery Denervation - PADN). Results: PADN can significantly reduce the level of LH in the postoperative period (р2 = 0.018 compared with other groups) and promotes reverse cardiac remodeling by reducing its cavities. Complex surgical correction of patients with mitral valve disease, AF and severe PH can significantly reduce the severity of heart failure (р2 = 0.023 compared to the group without PADN). Conclusion: the PADN circular procedure is effective and safe. Further analysis of the effectiveness of PADN with a grouping of a larger number of patients, analysis of long-term results, and determination of the feasibility of this technique in patients with non-valvular forms of PH is needed.