A Modified Mini-maze Procedure: A Biatrial Technique For The Treatment Of Long-standing Persistent Atrial Fibrillation
Changfa Guo, Yi Lin, Wenshuo Wang, Kanhua Yin, Chunsheng Wang.
Zhongshan Hospital，Fudan University, Shanghai, PR China, China.
OBJECTIVE: The aim of the study was to determine the safety and feasibility of a modified Mini-Maze procedure with a biatrial ablation technique for the treatment of long-standing persistent atrial fibrillation (AF).
METHODS: Between January 2016 and June 2016, 10 patients (male, 6; mean age, 57.4 ± 8.2 years; preoperative left atrial size, 51.4 ± 6.3 mm) of long-standing persistent AF, underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a traditional Mini-Maze procedure, including videoassisted bilateral minithoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, and left atrial roof connecting lesion. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. The second step was to eliminate the potential macro-reentries related to the right atrium. A follow-up at interval of 1, 3, and 6 months after operation was completed on all patients
RESULTS: No mortality. No surgical re-exploration for bleeding. No permanent pacemaker implantation. One patient suffered from re-ventilation on the 2nd day after operation and recovered well at discharge. Nine patients were free from AF upon discharge with one patient of AF refractory to electric defibrillation. A follow-up at interval of 1, 3, and 6 months showed a success rate free from AF was 90%, 90% and 80% respectively.
CONCLUSIONS: The modified biatrial Mini-Maze showed a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF.
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