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Bilateral Clamp Ablation Of Pulmonary Veins During Minimally Invasive Aortic Valve Replacement Via A Right Minithoracotomy
Toshinori Totsugawa, Arudo Hiraoka, Kentaro Tamura, Hidenori Yoshitaka, Taichi Sakaguchi.
The Sakakibara Heart Institute of Okayama, Okayama, Japan.
OBJECTIVE: It is challenging to perform left pulmonary vein isolation (PVI) with a radiofrequency clamp through a right minithoracotomy. Here we demonstrate bilateral PVI using a bipolar clamp during minimally invasive aortic valve replacement (MIAVR) via a right minithoracotomy.
METHODS: Surgery was performed via a 7-cm right thoracotomy and cardiopulmonary bypass was established with a femoro-femoral bypass. The right pulmonary veins were ablated using a radiofrequency clamp while the heart was beating. After cardiac arrest, an umbilical tape was passed through the transverse sinus and the ascending aorta was pulled up using the tape; the left atrial appendage and the left circumflex artery were well exposed. The left atrial appendage was resected through the transverse sinus with a stapling device to prevent postoperative stroke. The oblique sinus was opened with blunt dissection; the bipolar clamp was introduced into the oblique sinus; and left PVI was performed. Then the aortic valve was replaced with a prosthetic valve in a usual manner.
RESULTS: Between January and August 2016, 5 patients (4 male and 1 female; mean age, 74±8 years old) underwent concomitant PVI using a radiofrequency clamp during MIAVR via a right mini-thoracotomy. Four cases were aortic stenosis and concomitant mitral valvuloplasty was performed in a case of aortic and mitral insufficiency. Type of atrial fibrillation (AF) was paroxysmal in all patients. Mean procedural time of left PVI including appendage resection was 12±3 min. Postoperative AF was seen in 3 patients; however, its duration was short and AF was easily controlled with oral administration of flecainide. In 4 patients who passed more than 6 months after surgery, flecainide and warfarin were discontinued 6 months after surgery. They have never had recurrence of AF only with oral intake of beta-blocker.
CONCLUSIONS: Our method is a useful procedure that enables secure left PVI using a radiofrequency clamp during MIAVR via a right minithoracotomy.
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