[Strategy of sinus rhythm restoration after single stage correction of mitral valve defect and maze procedure for improvement of efficacy and safety of anticoagulant therapy].

ABSTRACT

We analyzed clinical efficacy of a strategy of sinus rhythm (SR) restoration after single stage correction of mitral valve defect and failed radiofrequency maze procedure elaborated and realized in the Research Institute for Complex Issues of Cardiovascular Diseases, and assessed its value for increase of efficacy and safety of anticoagulant therapy. First stage of this strategy--cardiosurgical treatment with maze procedure--resulted in restoration of SR in 61.8% of cases. In case of persistence of tachyarrhythmia external elelectro-impulse therapy was used in 1-1.5 months after cardiac surgery as a second stage of our strategy. Third stage--catheter radiofrequency ablation--was applied to patients with implanted biological cardiac valves. Second and third stages facilitated restoration of SR in 84.8 and 93.2% of patients, respectively, and provided 100% SR restoration in patients with biological valve prostheses. The suggested strategy allowed to withdraw anticoagulant therapy in patients with biological valves and to reduce level of hypocoagulation to lower limit of target range in patients with mechanical prostheses.