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Combined Modified Ablation For Atrial Fibrillation & Mitral Surgery Through A Minimally Invasive Approach: Current Data And Experience
Shaoping Zhu, Xianwu Zhou, Gaofeng Pan, Jinping Zhao, Jinping Liu;
Zhongnan hospital of Wuhan University, Wuhan, China
BACKGROUND:We aimed to present our experience perspectives in patients with mitral valve surgery with concomitant modified Maze IV procedure through a minimally invasive approach.
METHODS:A total of 118 patients (mean age, 62 ± 5.8 years) who underwent concomitant modified Maze IV procedure and mitral surgery via right-sided mini-intercostal access were included from July 2016 to September 2023. We performed modified biatrial ablation by means of unipolar plus bipolar radiofrequency for persistent AF with concomitant left appendage continuous closure. A well-designed atrial hook was inserted and fixed into the atrum via incision to provide favorable exposure in each case. Patients underwent regular echocardiographic follow-up and monitored by 24-hour Holter at 1, 3, 6, 12, and 24 months, then annually.
RESULTS:Among 118 patients, 71 patients (60.2%) were male. In all, the etiology of mitral valve disease was rheumatic for 75 patients and degenerative for 43 patients. The mean Society of Thoracic Surgeons (STS) score was 5.2±0.8%. Mitral valve surgery included mitral valve repair (46.6 %) and mitral valve replacement (53.4 %), respectively. Of these, 79 patients (66.9%) received concomitant tricuspid valve surgery, which was performed after release of cross clamp routinely. The mean operative times were as follow: cardiopulmonary bypass time 138±26.6 minutes, aortic clamp time 78±12.6 minutes. The in-hospital mortality was 0.85%. One procedure was electively converted to sternotomy (0.85%) due to Left atrial appendage bleeding. The mean cross clamp time was 68±12.6 minutes. During a median follow-up of 36.4 months, the late mortality rate was 3.5%, and 2 pacemaker insertion was recorded (1.7%).The in-hospital major complications included myocardial infarction, stroke, acute renal failure and permanent pacemaker implantation was all null. The mean intensive care unit (ICU) stay was 3.5±0.6 days. The mean hospital stay was 10.8±1.9 days. 5 patients (4.2%) showed mild residual mitral regurgitation. Sinus rhythm was present in 101 patients (86.4%) at discharge; of these, 9 patients (8.8%) recorded recurrence of atrial arrythmia throughout the whole follow-up. No disfunction of prosthetic mitral valve was observed from their last echocardiography.
CONCLUSIONS:Mitral valve surgery with concomitant modified biatrial Maze IV procedure can be successfully performed through right-sided mini-intercostal access with promising mid-term results. Our well-designed atrial hook can provide favorable exposure for the procedure without extra incision.
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