Thoracoscopic Maze In The Obese Patient
Tyler M. Gunn, Michael D. Bolanos, Theodore S. Wright.
University of Kentucky, Lexington, KY, USA.
OBJECTIVE: Atrial fibrillation is a common arrhythmia which is associated with increased risk of thromboembolism, stroke, and death. Historically, the traditional open Cox-Maze procedure has been the standard for surgical management of atrial fibrillation and requires either a sternal incision with cardiopulmonary bypass. However, a minimally invasive technique has been developed called the Cox-Maze IV or thoracoscopic Maze procedure which allows for pulmonary vein radiofrequency isolation, posterior atrial wall debulking via superior and inferior connecting lesions, and epicardial left atrial appendage exclusion without requiring a sternal incision, cardiac arrest, or cardiopulmonary bypass. Risk factors for adverse outcomes for this procedure based on preoperative patient characteristics are not well understood. Obesity is a common preoperative risk factor which may increase the technical difficulty of surgical procedures, especially minimally invasive techniques. This retrospective study investigates the impact of obesity on postoperative outcomes as well as short and long term successful conversion to sinus rhythm.
METHODS: Seventeen consecutive patients undergoing thoracoscopic Maze surgery at the University of Kentucky from December 1, 2013 to February 3, 2016, were included in this retrospective chart review. Preoperative characteristics, intraoperative technique, and outcomes were assessed, including short and long term clinical follow-up with electrocardiograms.
RESULTS: 11 of 17 patients in the study were obese (65%) with a BMI greater than 30. Of those who were obese, 7 patients (64%) had persistent atrial fibrillation and 4 patients (36%) had paroxysmal atrial fibrillation. 10 obese patients (91%) had successful conversion to normal sinus rhythm documented during clinical follow-up. The length of follow-up ranged between 2 weeks and 20 months. There were 0 operative mortalities and 0 operations were converted intraoperatively to an open technique.
CONCLUSIONS: Obesity is a common preoperative characteristic that is thought to increase the difficulty of minimally invasive surgery and may worsen outcomes. In a cohort of obese patients undergoing thoracoscopic MAZE procedures, we have demonstrated a high rate of successful conversion from refractory atrial fibrillation to normal sinus rhythm without adverse outcome or requiring intraoperative conversion to an open MAZE procedure.
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