Surgical Treatment Of Long-standing Persistent Atrial Fibrillation: Maze-5 Or Thoracoscopic Ablation?
Amiran Revishvili, Vadim Popov, Egor Malyshenko, Valentin Vaskovskiy, Giorgiy Edzhibiya, Irina Taymasova, Elizaveta Strebkova.
A.V. Vishnevsky National Medical Research Center of Surgery, Moscow, Russian Federation.
Objective: to compare in-hospital and mid-term (up to 12 month) results of radiofrequency modified Maze procedure and thoracoscopic epicardial ablation in long-standing persistent atrial fibrillation (LSPAF) treatment. Methods: 2 groups of patients were studied. Group 1 (G-I) - radiofrequency modification of Maze procedure on-pump on a beating heart (Maze-V) (n=128), group 2 (G-II) - thoracoscopic epicardial ablation of pulmonary veins (n=51). Baseline characteristics: age, sex, LA volume index, BMI, anamnesis of AF were evaluated in both groups, no statistical difference was found. Results: In-hospital stay was 13±3 days in G-I and 7±4 days in G-II. Intraoperatively sinus rhythm was restored in 82% (Maze-procedure), and in 40% (Thoracoscopic ablation), after electrical cardioversion: G-I:14%, G-I:42%, after pharmacological cardioversion - G-I: 7.8%, in G-II: 12%. In G-I-3,9% (n=5) of patients had pericardial effusion, which required pericardial puncture. Postoperative pacemaker implantation rate was done in G-I:3,2% (n=4), in G-II:2% (n=1). There were no infections, thromboembolic or hemorrhagic complications in the early postoperative or mid-term period of follow-up in both groups. In Maze group atrial re-entry tachycardia occurred in 14,1% of patients and required additional catheter ablation 3 month after the initial procedure in 6,3% of cases vs G-II where this arrhythmia occurred in 24% cases, and catheter ablation was carried out in 4% of patients. Sinus rhythm at 3, 6 and 12 month was kept up in 96%, 92% and 94% in Maze group, and in 76%, 88% and 84% in thoracoscopic ablation group respectively. Perioperative and follow-up mortality was 0 in each group. Conclusion: Maze-V procedure still remains the most effective option of LSPAF treatment, however thoracoscopic ablation provides almost comparable mid-term results, less operative trauma and complication rate.
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