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Redo VATS Epicardial Atrial Fibrillation Ablation in Patients with Previous Cardiac Surgery
Gansevoort H. Dunnington, Jr., Carolyn Pierce.
St Helena Hospital, St Helena, CA, USA.
OBJECTIVE: Previous cardiac surgery is considered a contraindication to VATS epicardial atrial fibrillation (afib) ablation by most surgeons. It may be a feasible option for some patients with challenging afib as part of a hybrid ablation strategy.
METHODS: A retrospective review of 186 VATS afib ablation patients at our institution, from 4/13/13 to the 11/4/15, revealed 12 patients who have had previous cardiac surgery. Patients underwent bilateral VATS epicardial ablations as planned first phase procedures of a hybrid Maze, where endocardial ablation would be performed at a later stage. Rhythm monitoring was performed by 1-2 week long term monitors at 3 month, 1 year and 2 year time points.
RESULTS: Of 186 VATS afib ablations done at our institution since 4/2013, 12 patients have had previous cardiac surgery. Six of these patients have had previous CABG, while the other six have had non-coronary surgery. All patients were restored to normal sinus rhythm at the conclusion of the procedure. 8/12 patients have had second stage endocardial ablation to complete hybrid Maze, and all 8 of these are currently in NSR at mean follow up of 424 days. All patients had their left atrial appendage closed during the procedure. There was one mortality in the peri-operative time period due to multi-organ failure. There have been no strokes or TIA's in the post op period, despite all patients being off anticoagulation. None of the patients required blood transfusion nor conversion to open sternotomy or thoracotomy.
CONCLUSIONS: Redo VATS atrial fibrillation ablation after previous cardiac surgery is feasible in the hands of experienced surgeons. Results can be excellent when combined with endocardial ablation for a hybrid approach. Patients should be carefully selected, as theses cases are more technically challenging than non redo cases.
| Age | 67 |
| BMI | 27 |
| CHADS2VASC | 3.25 |
| Time in Afib | 6.7 yrs |
| EF | 46% |
| LA size | 5.3 cm |
| Length of hospital stay | 4.4d |
| Time of procedure | 165 min |
| Procedure time of second stage catheter ablation | 103 min |
| Fluoro time of second stage catheter ablation | 29 min |
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