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Compare Bipolar Radiofrequency And Cryo Ablation Technique During Minimally Invasive Mitral Valve Surgery
Alexander Bogachev-Prokophiev, Sergey Zheleznev, Alexey Pivkin, Alexander Afanasyev, Igor Demin, Alexander Karaskov.
State Reserch Institute Circulation Pathology, Novosibirsk, Russian Federation.

OBJECTIVE: In most cases for concomitant treatment atrial fibrillation (AF) during minimally invasive mitral surgery used endocardial cryoablation [Mohr F., 2011] or monopolar radiofrequency (RF) [Jeanmart H., 2006; Krakor R., 2011]. Bipolar RF is to date the most effective way to perform transmural atrial scars for the surgical ablation of AF during open-heart surgery [Gillinov M., 2002; Benussi S., 2005].
METHODS: From October 2011 to November 2012 we have operated on 53 patients with mitral valve lesion and AF. In 21 (39.6%) patients was performed RF ablation Isolator Synergy Access (AtriCure, Inc) and in 32 (60.4%) cases cryo lesion CryoIce (AtriCure, Inc). Mean age was 53.5±6.8 years. The pattern lesion was left atrial ablation in both group: box-lesion + mitral line + line to left atrial appendage (LAA). The mitral procedure is carried out as usual and LAA appendage sewn from inside.
RESULTS: Mean operation and mean ablation time were 302±58 and 185±47 min (p=0.001) 21.4±5.5 and 58.7±35.2 min (p=0.001) for RF and cryo groups, respectively. There was no hospital mortality or major complications occurred for the mitral procedure. Conversion to sternotomy was in one cases in cryo group (bleeding from LAA) (p=0.091).
All patients were AF-free at discharge. In 2 (9.5%) cases in RF group and 1 (3.1%) patient in cryo group required pacemaker implantation, owing to sinus node dysfunction (p=0.034). Freedom from AF at 12 month follow up was 85.7% and 89.1% in RF and cryo groups, respectively (p=0.103).
CONCLUSIONS: Concomitant RF and cryo ablation during minimally invasive mitral valve surgery have comparable efficacy. However, RF ablation procedure is technically more difficult to perform and requires more operation time.


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