Freezing equals Freezing? Performance of Two Cryoablation Devices in Concomitant Mitral Valve Repair
Julia Götte1, Timo Weimar1, Martina Vosseler1, Michael Raab1, Ulrike Walle1, Markus Czesla2, Nicolas Doll1
1Sana Cardiac Surgery Stuttgart GmbH Department of Cardiac Surgery, Stuttgart, Germany, 2Heart Center Passau, Department of Cardiac Surgery, Passau, Germany
OBJECTIVE: Recent guidelines have recommended the addition of ablation in cardiac surgery for patients presenting with atrial fibrillation (AF). Currently available cryoablation devices use either nitrous oxide or argon gas as cooling agent. The goal of our study was to compare success rates of two different devices currently available on the market and applied during concomitant cardiac surgery.
METHODS: Between 2009 and 2012, Data was collected from 120 consecutive patients in whom either the aluminum cryoICE® ablation probe (AtriCure, Inc., Cincinnati, OH) using nitrous oxide or the stainless steel Cardioblate® CryoFlexTM 10-S probe (Medtronic, Inc., Minneapolis, MN) using argon gas was applied for concomitant ablation procedures in minimally invasive mitral valve cases. Perioperative variables, myocardial injury biomarkers (MIB) and Holter monitoring results were compared.
RESULTS: Perioperative variables such as gender, age, type and duration of AF, procedure- and cross-clamp times, and 30-day mortality did not significantly differ between the groups. Postoperative peak creatinine kinase MB (CK-MB) levels were significantly higher in the nitrous oxide group (p=0.047). At a mean follow-up of 20±13 months, freedom from AF was significantly higher in the nitrous oxide group (87%) compared to the argon group (71%, p=0.044). Left-atrial (LA) diameter and device used were the only predictors of failure of ablation (p=0.029 and p=0.018, respectively).
CONCLUSIONS: The nitrous oxide based aluminum probe revealed a better outcome then the argon based stainless steel probe. Besides the cooling agent, probe material and probe-tissue interface might have contributed to the better performance of the cryoICE® probe.
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