Concomitant Coronary Artery Bypass Surgery And Epicardial Box Lesion Ablation
Pavel Shilenko, Yurii Shneider, Men DE Tsoi, Mikhail Fomenko, Aleksander Pavlov.
FCHMT Kaliningrad, Kaliningrad, Russian Federation.
Background: With a combination of coronary disease and atrial fibrillation, many questions remain - how to treat, when coronary bypass surgery is needed, what kind of surgery to perform? Coronary artery bypass grafting and pulmonary vein isolation with bipolar clamp? Or coronary bypass and open the left atrium to maze 3 or 4? To increase the effectiveness of treatment of atrial fibrillation or to avoid cardioplegia and opening of the heart cavities? Methods: within two years, we performed 14 coronary bypass grafting in combination with epicardial ablation at once. In all cases, the ablation «Dallas» lesion set was performed. 2 operations performed according to the scheme: thoracoscopic ablation + MIDCAB and12 operations through the sternotomy. In 4 cases, the ablation and CABG were performed «off - pump», 2 operations «on - pump beating heart» and 6 operations, CABG on cardioplegia. 11 patients had a long-standing persistent atrial fibrillation. 8 were male. The average age 64 years (54-81). 2 patients had isolated proximal LAD disease. 2 had a two-vessel and 10 had a three-vessel disease. 12 operations with multivessel coronary disease, 2 ITA were used. If necessary, the vein was harvesting by the "no touch technique". Intraoperative fluorometry was performed. Results: The operation time was 186 min (+- 24min). The average time of ablation through sternotomy was 32 minutes (- +8 min). In 2 operations without cardioplegia sinus rhythm was restored without cardioversion. In cases of CABG in cardioplegia, the sinus rhythm was restored after removing the clamp from the aorta. In the remaining 6 operations, cardioversion was performed. Complications such as heart attack and bleeding are not noted. Intensive care time was 18 hours (- +3.2). In two cases, freedom from atrial fibrillation was confirmed after 1 year. In other cases, at the moment there are three-month follow up. Catheter re-isolation performed in one patient with atrial flutter. There was no need for coronary reintervation. Conclusion: The accumulated experience of performing thoracoscopic ablation can be successfully used in patients with coronary disease.
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