Influence Of Left Atrial Plication While Mitral Valve Replacement On The Level Of N-terminal Pro-brain Natriuretic Peptide

Background:Rheumatic mitral valve disease can cause enlargement of the left atrium.Due to the influence of the national conditions,many patients with mitral valve disease have a history of more than ten years,or even decades,and their left atrium tends to increase significantly.If you do not treat giant left atrium,it will become left atrial thrombus hemoptysis and right heart failure finally.Therefore,patients with moderate to severe mitral valve disease and giant left atrium require surgical intervention.Left atrial enlargement causes atrial fibrillation(AF),which is one of the pathogenesis of AF,and the proportion of AF caused by left atrial enlargement is very high.Persistent AF can cause or deteriorate heart failure,and then promote the left atrial enlargement.This process forms a vicious cycle.In addition,because of atrial fibrillation and giant left atrium,the blood flow near the left atrial appendage and atrial wall becomes slow,and forms a whirlpool.This process leads to a series of complications such as tarombokinesis or the thrombus falls off and forms again.Previous studies indicated that The operation of mitral valve replacement with left atrial reduction at the same time is more beneficial for the effect of the operation and the patient's recovery.However,we still need to further study that whether NT-proBNP as a new marker for diagnosis,treatment and prognosis of heart failure can be used to evaluate the effect of left atrial reduction surgery.ObjectiveTo evaluate the influence of left atrial reduction on the level of N-terminal pro-brain natriuretic peptide (NT-proBNP) for mitral valve disease with giant left atrium.The degree of recovery of cardiac function is evaluated according to NT-proBNP.According to the degree of recovery of cardiac function after operation, it can provide a theoretical basis for the clinical treatment to make a more optimized operation plan.MethodsTotally 70 patients with underwent mitral valve replacement (MVR) in our Hospital were assigned into two groups:LAP group with left atrial plication (n=35) and control group without left atrial plication (n=35).The perioperative clinical data were collected and the level of NT-proBNP at different time points were compared.Results1.The base line in the two group had no significant difference.Aortic cross-clamping time (71.92±14.17vs. 65.08±10.11) and cardiopulmonary bypass time(44.28±12.15vs. 36.71±9.68) in LAP group were significant longer than in control group (p<0.05). While, time of ventilator (14.16±5.41 vs. 17.2±6.97)and ICU admission(29.47±10.84 vs. 36.02±12.9) in LAP group were significant shorter than in control group (p<0.05).2. The level of NT-proBNP increased postoperation and reach the peak at post 24h,then decreased until the 6 month postoperative follow-up survey.The NT-proBNP,sampled before operation and 24h,72h,7d after operation,had no significant difference between the two groups.The level of the NT-proBNP in LAP group was significant lower than in control group after 6 months.ConclusionLAP are benefit for the recovery after MVR and can decrease the level of NT-proBNP postoperation,the time of ventilator and ICU admission.