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Hybrid Totally Thoracoscopic Maze For Persistent Atrial Fibrillation: Early Outcome Analysis.
Manoras M. Chengalath, John D. Brookes, Emily Kotschet, Stewart Healy, David Adam, Logan Bittinger, Adrian W. Pick;
Victorian Heart Hospital, Monash Health, Melbourne, Australia
BACKGROUND: Surgery is rarely performed for persistent atrial fibrillation (AF) despite poor reported efficacy of catheter ablation alone. Hybrid Totally Thoracoscopic Left atrial Maze (TTMAZE) combines epicardial and endocardial techniques and is reported to significantly improve outcomes.
METHODS:We present an analysis of 78 consecutive patients who underwent TTMAZE from November 2017 to September 2023 by a single surgeon. All patients underwent electrophysiologic three dimensional (3D) staged mapping. Preoperative workup included pulmonary function testing, echocardiography,and structural heart computed tomography to define the pulmonary anatomy and to exclude the presence of left atrial thrombus.
RESULTS:The median age was 61 years with 77% males and an average weight of 97 kg. 67 patients were in persistent or long-standing persistent AF. The presenting symptoms included fatigue (70%), palpitations (55%), dizziness (19%) and chest pain (9%). 12.8% had previous TIA (Transient Ischemic attack) and 2.6% had extracranial embolic episodes. Comorbidities included hypertension (37%), obstructive sleep apnoea (5%), smoking (19%) and coronary artery disease (1.2%). The average hospital stay was 3.8 days. TIA was observed in 1.3%. Two patients required permanent pacemaker and two received direct cardioversion as inpatients. Patients were followed for a mean of 2.8 years by which stage anticoagulation (AC) had been ceased in 46% and antiarrhythmics (AA) ceased in 65%. The freedom from AF at most recent follow up was 92.9%.
CONCLUSIONS:This series with hybrid TTMAZE shows excellent outcomes with respect to symptom relief, cessation of AA and AC’s and very few complications. Further long term follow up is in progress.
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