vestarВестник аритмологииJournal of Arrhythmology1561-86412658-7327НАО «Инкарт»10.35336/VA-1584vestar-1609Research ArticleОРИГИНАЛЬНЫЕ ИССЛЕДОВАНИЯORIGINAL ARTICLESПересечение связки Маршалла при коронарном шунтировании и послеоперационная фибрилляция предсердий: ранние результаты пилотного рандомизированного исследованияLigament of Marshall transection during coronary artery bypass grafting and postoperative atrial fibrillation: early results of a pilot randomized studyhttps://orcid.org/0000-0002-3878-8783ГасымоваН. З.GasimovaN. Z.

Гасымова Нигар Закарьевна 

Санкт-Петербург, ул. Аккуратова, д. 2

Gasimova Nigar

Saint-Petersburg, 2 Akkuratova str.

nigarzakariyya@gmail.comhttps://orcid.org/0000-0001-7891-4708ЩукинаЮ. Г.ShchukinaYu. G.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

https://orcid.org/0000-0002-3664-5383ИоновМ. В.IonovM. V.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

https://orcid.org/0009-0002-0508-8171СтариковаА. В.StarikovaA. V.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

Исмаил-задеИ. К.Ismail-zadeI. K.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

https://orcid.org/0000-0003-2213-6673ИвановИ. Ю.IvanovI. Yu.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

https://orcid.org/0000-0002-9001-8743ЖабинаЕ. С.ZhabinaE. S.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

ТянН. А.TyanN. A.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

ГребенникВ. К.GrebennikV. K.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

https://orcid.org/0000-0002-8199-0813ГордеевМ. Л.GordeevM. L.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

https://orcid.org/0000-0002-6553-9141МихайловЕ. Н.MikhaylovE. N.

Санкт-Петербург, ул. Аккуратова, д. 2

Saint-Petersburg, 2 Akkuratova str.

ФГБУ «Национальный медицинский исследовательский центр им. В.А.Алмазова» МЗ РФРоссияAlmazov National Medical Research Center of the MH RFRussian Federation2026130320263312228Copyright © Гасымова Н.З., Щукина Ю.Г., Ионов М.В., Старикова А.В., Исмаил-заде И.К., Иванов И.Ю., Жабина Е.С., Тян Н.А., Гребенник В.К., Гордеев М.Л., Михайлов Е.Н., 20262026Гасымова Н.З., Щукина Ю.Г., Ионов М.В., Старикова А.В., Исмаил-заде И.К., Иванов И.Ю., Жабина Е.С., Тян Н.А., Гребенник В.К., Гордеев М.Л., Михайлов Е.Н.Gasimova N.Z., Shchukina Y.G., Ionov M.V., Starikova A.V., Ismail-zade I.K., Ivanov I.Y., Zhabina E.S., Tyan N.A., Grebennik V.K., Gordeev M.L., Mikhaylov E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://vestar.elpub.ru/jour/article/view/1609Цель

Цель. Оценить влияние пересечения связки Маршалла на частоту фибрилляции предсердий (ФП) в течение 1 месяца после коронарного шунтирования (КШ).

Материал и методы исследования. В «слепое» рандомизированное одноцентровое клиническое исследование включено 60 пациентов с показаниями к хирургической реваскуляризации миокарда (КШ), распределенных в группу пересечения связки Маршалла (30 пациентов; основная группа), в группу без пересечения связки Маршалла (30 пациентов - контроль). По основным клинико-демографическим параметрам группы между собой не различались. Первичная конечная точка - фибрилляция предсердий в сроки 28 дней после КШ. Для поиска факторов эффективности выполнялась логистическая регрессия.

Результаты

Результаты. У 9 пациентов развилась послеоперационная ФП, у 7 пациентов в контрольной группе и 2 пациентов основной. Статистическая модель выявила два независимых фактора, достоверно снижающих риск развития послеоперационной ФП: проведение операции без искусственного кровообращения (off-pump) и пересечение связки Маршалла (p=0,030 и p=0,048, соответственно). Модель логистической регрессии продемонстрировала отличную прогностическую способность и высокую точность классификации пациентов; чувствительность - 93,8%, специфичность - 62,5% при пороге отсечения 0,5. Площадь под ROC-кривой (AUC=0,898) указывает на отличную способность модели различать пациентов с и без послеоперационной фибрилляции предсердий.

Заключение

Заключение. Пересечение связки Маршалла в рамках проведения коронарного шунтирования на «работающем сердце» способно предупредить развитие послеоперационной ФП.

Aim

Aim. To evaluate the impact of Marshall ligament cutting off on the incidence of atrial fibrillation (AF) within 1 month after coronary artery bypass grafting (CABG).

Methods

Methods. A double-blind, randomized, single-center clinical trial included 60 patients; 30 patients were allocated to the Marshall ligament cutting off group (main group), and 30 patients to the group without Marshall ligament cutting off (control group). The groups did not differ in baseline clinical and demographic parameters. The primary endpoint was the occurrence of AF within 28 days after CABG. Logistic regression was performed to identify efficacy factors.

Results

Results. Postoperative AF developed in 9 patients: 7 patients in the control group and 2 patients in the main group. The statistical model revealed two independent factors that significantly reduced the risk of postoperative AF: performing the surgery without cardiopulmonary bypass (off-pump) and Marshall ligament cutting off (p=0.030 and p=0.048, respectively). The logistic regression model demonstrated excellent predictive ability and high patient classification accuracy; sensitivity was 93.8%, specificity was 62.5% at a cutoff of 0.5. The area under the ROC curve (AUC=0.898) indicates the model’s excellent ability to distinguish between patients with and without postoperative atrial fibrillation.

Conclusion

Conclusion. Marshall ligament transection during off-pump CABG prevents the development of postoperative atrial fibrillation.

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The authors declare that there are no conflicts of interest present.