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OBJECTIVE:
We have recently developed a new completely thoracoscopic procedure (modified mini Maze) via left chest with the use of RF-energy for treatment of lone AF. This study was to assess the feasibility, safety and effectiveness of the completely thoracoscopic procedure via unilateral approach to cure alone AF.
METHODS:
Fourty-five patients with symptomatic, drug-refractory, lone AF, including 37 male and 8 female between the ages of 31 and 81 years (mean age 63.4), underwent this therapy from October 2010 through October 2011. Thirty-two patients were with paroxysmal, 9 with persistent, and 4 with long-standing AF. The procedure was performed on the beating heart, avoiding the need for cardiopulmonary bypass, through three thoracoports on left chest wall after general anesthesia. The incision was made on the pericardium a few centimeters anterior to and parallel to descending aorta, exposing both sides of pulmonary vein and the posterior portion of left atrium. Isolation of the PVs was achieved by bipolar radiofrequency ablation with the AtriCure Isolator Synergy ablation clamp. Linear lesion of left atrium (between the left PVs to right PVs with the addition of linear lesions extending to the mitral annulus and left atrial appendage) and the ablation of GPs and the ligament of Marshall was made by the AtriCure Isolator Synergy ablation pen. The left atrial appendage was excluded by using an Autosuture Endo Gia stapler.
RESULTS: The procedure was performed in all 45 cases successfully. The operation duration was 104±37 min. Patients were extubated after 152±38 min. No cardiovascular accidents or pacemaker implantation were identified and none of the patients died. The hospital stay was 4-8 (mean 5.7) days. Follow-up was done between 1 and 12 months (mean 6.1 months) postoperatively. 91.1% (41/45) of all patients were in sinus rhythm during follow-up,and freedom from AF was 93.8 % 30/32) and 84.6% (11/13) for paroxysmal and persistent/longstanding AF, respectively.
CONCLUSIONS:
This new completely thoracoscopic procedure (modified mini Maze) via unilateral approach presents optimistic medium-term outcomes and proves to be feasible, safe and effective for the treatment of lone AF.