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OBJECTIVE: To review our experience on minimally invasive AF ablation surgery though a mini-thoracotomy assisted by AESOP (Automated Endoscopic System for Optimal Positioning) 3000 or da Vinci system.
METHODS: Between July 1997 and August 2013, 335 patients underwent minimally invasive AF ablation using either AESOP 3000 (n = 279) or da Vinci system (n = 56), with or without other cardiac procedures. We retrospectively reviewed the postoperative clinical outcomes and rhythm outcomes. Rhythm outcomes were assessed by regular ECGs and Holter monitoring follow-up. AF recurrence was regarded as any AF or atrial flutter episodes after postoperative blanking period.
RESULTS: Of 335 cases, 10 cases (3.0%) were isolated AF ablation, and concomitant cardiac surgeries were performed in 325 patients, which included mitral valve surgery in 291 patients (96.9%), tricuspid surgery in 173 patients (51.6%), and atrial septal defect closure in 26 patients (7.8%). Left atrial auricle resection was performed in 36 patients (10.7%). Preoperative paroxysmal AF was in 49 patients (14.6%) and persistent AF was in 286 patients (85.4%). AF ablation was successfully performed in 323 patients (96.4%) with sinus rhythm conversion immediate postoperatively. There were two in-hospital deaths (0.6%) and 7 surgical complications (2.1%) including low cardiac output syndrome in 3, stroke in 2, and complete atrioventricular block in 2. Regular rhythm follow-up (> 6 months) was possible in 291 patients (86.9%). At a median of 34.7 months (inter-quartile range: 21.3-92.6 months), freedom from AF at 5 years was 88.2 ± 6.1%.
CONCLUSIONS: Minimally invasive AF ablation is feasible and efficacious in terms of favorable mid-term AF free rate.