Postoperative myocardial remodeling and functional status of cardiac surgical patients with mitral valve disease and chronic kidney disease

Background. Currently, there are many comorbid patients undergoing surgery for acquired heart disease. Therefore, it is important to analyze the relationship between disease course and postoperative cardiac remodeling with chronic kidney disease (CKD) in patients with mitral valve (MV) disease. Objective. To evaluate the relationship between course of disease and postoperative cardiac remodeling in patients with CKD hospitalized for surgical correction of MV disease. Material and methods. The study included 148 patients with acquired non-infectious MV disease hospitalized for surgical correction. The median age was 61.5 [51.3; 67.0] years. There were 70 (47.3%) women and 78 (42.7%) men. Patients underwent clinical and anamnestic data analysis, six-minute walk test, transthoracic echocardiography with speckle-tracking of right ventricular function and ventricular strain. Patients were divided into groups: group 1 — patients with CKD stage 3a—4 (n=55), group 2 — patients without CKD or with CKD stage < 3a (n=93). We assessed contribution of moderate-to-severe CKD to myocardial remodeling and course of disease. Results. Patients with CKD stage 3a—4 were older (p=0.007), had combined MV defect (p=0.003) and rhythm disturbances such as atrial fibrillation/flutter (p=0.001). Early postoperative conduction disturbances were more common in this group: 7 (12.7%) vs 2 (2.2%), p=0.013. The 1st group was characterized by larger preoperative volume of both atria (p=0.042 and p=0.007). CKD stage 3a—4 is associated with reduced ejection fraction and fractional change in right ventricular area in preoperative period by B-coefficient -7.759 (p=0.021) and B-coefficient -7.047 (p=0.045), respectively. Before surgery and 30 days later, the 1st group was characterized by less TAPSE (p=0.005 and p=0.026). One month after surgery, patients with CKD stage 3a-4 covered a significantly shorter distance in six-minute walk test: 362.3 [303.4; 421.1] m vs 449.4 [408.48; 490.28] m (p=0.013). Conclusion. Patients with CKD stage 3a—4 undergoing MV correction are characterized by less favorable clinical characteristics, structural and functional myocardial changes and higher risk of postoperative complications such as conduction disturbances.