Impact of Pulmonary Denervation on Quality of Life After Complex Mitral Valve Surgery

DOI: 10.47026/2413-4864-2023-1-38-46

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Egorov D.V., Trofimov N.A., Nikolskiy A.V., Rodionov A.L., Ivanov D.S.

Impact of Pulmonary Denervation on Quality of Life After Complex Mitral Valve Surgery

Keywords: secondary pulmonary hypertension, pulmonary artery denervation, ganglionic plexus denervation, quality of life, mental state, physical state

Relevance. In recent years, concepts for assessing the quality of life have been developed. According to the WHO definition, quality of life is a person's perception of his position in life, culture and value system, it is associated with his goals, expectations, standards and concerns. Approximately three people out of every thousand have pulmonary hypertension for various reasons. This can lead to decreased exercise tolerance, quality of life, increased hospital admissions, and early death. An objective assessment of the quality of life of such patients will help achieve better clinical outcomes for patients and develop new treatments. Purpose of the study is to assessment of changes in the quality of life of patients with mitral valve disease associated with atrial fibrillation and high pulmonary hypertension (systolic blood pressure over 40 mmHg) during the first 24 months after radiofrequency denervation of the pulmonary arteries according to the SF-36 and MLHFQ questionnaires. Materials and Methods. The general population of patients (n = 202) with mitral heart disease, concomitant atrial fibrillation and high pulmonary hypertension was divided into several groups according to the complexity of surgical treatment: patients of the 1^st group (n = 62) underwent only surgical correction of the mitral valve pathology (repair or replacement); patients of the 2^nd group (n = 89) – surgical correction of the mitral valve pathology, as well as the Maze IV procedure using the AtriCure© bipolar ablator; patients of the 3^rd group (n = 51) received complex surgical treatment by correcting mitral valvular pathology, performing the Maze IV procedure, as well as using radiofrequency denervation of the pulmonary arteries. The quality of life was assessed over several periods: initially, 6 months later, 1 and 2 years after surgical treatment. The scores were also converted to physical health component scores and mental health component scores. Results. The initial data of patients from different subgroups according to the criteria of the SF-36 questionnaire were comparable with each other. The indicators of the physical component and the psychological component of SF-36 characterize the 3^rd group of patients with a lower level of quality of life in terms of the physical component, although no significant intergroup differences were found. Quality of life indicators after 6 months show positive changes in patients of all study groups without significant intergroup differences. Based on the results of 12 months, the greatest dynamics of the parameters of the questionnaire in terms of physical and mental components was observed in the 3rd group of patients. After 24 months, there is a significant advantage in changes in the indicators of patients of the 3rd group for all categories of the questionnaire. The target level after 6 months in the 3^rd group was 100%, in the 2^nd and 1^st – 85.3% and 40.7%, respectively, maintaining differences up to 24 months. Conclusions. The use of a circular radiofrequency pulmonary artery denervation procedure is associated with a significant improvement in health status in assessing the quality of life of patients who have not undergone correction of pulmonary hypertension.

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About authors

Egorov Dmitry V.: Cardiovascular Surgeon, Republican Cardiological Dispensary; Assistant Lecturer, Department of General Surgery and Oncology; Junior Researcher, Department of Surgical Diseases, Chuvash State University, Russia, Cheboksary (meddevil@mail.ru; ORCID: https://orcid.org/0000-0002-3538-8661)

Trofimov Nikolay A.: Chief Freelance Cardiovascular Surgeon of the Ministry of Health of the Chuvash Republic, Doctor of Medical Sciences, Associate Professor, Department of General Surgery and Oncology; Senior Researcher, Department of Surgical Diseases, Chuvash State University, Russia, Cheboksary (nikolai.trofimov@mail.ru; ORCID: https://orcid.org/0000-0002-1975-5521)

Nikolskiy Aleksandr V.: Candidate of Medical Sciences; Researcher, Department of Surgical Diseases, Chuvash State University, Russia, Cheboksary (yachtsmen@mail.ru; ORCID: https://orcid.org/0000-0001-5605-0128)

Rodionov Andrei L.: Candidate of Medical Sciences; Researcher, Department of Surgical Diseases, Chuvash State University, Russia, Cheboksary (a.rodionov.andrei@yandex.ru; )

Ivanov Danila S.: 2nd Year Student, Faculty of Medicine, Chuvash State University, Russia, Cheboksary )

Article link

Egorov D.V., Trofimov N.A., Nikolskiy A.V., Rodionov A.L., Ivanov D.S. Impact of Pulmonary Denervation on Quality of Life After Complex Mitral Valve Surgery [Electronic resource] // Acta medica Eurasica. – 2023. – №1. P. 38-46. – URL: https://acta-medica-eurasica.ru/en/single/2023/1/5/. DOI: 10.47026/2413-4864-2023-1-38-46.

Single article

Egorov D.V., Trofimov N.A., Nikolskiy A.V., Rodionov A.L., Ivanov D.S.