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Surgical Methods In Concomitant Paroxysmal Af During Cabg
Vadim Popov, MD1, Amiran Revishvili
1, Egor Malyshenko
1, Maxim Anishchenko
1, Natalia Popova
1, Natalia Ardashova
1, Madina Kadyrova
1, Vladislav Aminov
2, Mihail Svetkin
2;
1A.V. Vishnevsky National Medical Research Centre of Surgery, Moscow, Russian Federation,
2Federal State Center of Cardio Vascular surgery (Chelyabinsk), Chelyabinsk, Russian Federation
BACKGROUND: Atrial fibrillation (AF) is considered one of the most significant arrhythmias accompanying direct myocardial revascularization (CABG). The choice of treatment for concomitant paroxysmal AF in patients undergoing CABG is vital. This study is to assess the efficiency and safety of concomitant RFA PV and Cox-Maze V procedure for paroxysmal AF in patients undergoing CABG.
METHODS:The study includes 139 CAD patients with AF history. Exclusion criteria: non-paroxysmal AF, urgent surgery, concomitant VHD, decompensation of chronic diseases, malignancy. PSM analysis matched RFA PV with Cox-Maze V in 30 patients. Outcomes assessed: AF/AFL recurrence, sinus rhythm, pacemaker implantation, MACCE, and secondary endpoints. Procedures performed pre-CABG without aortic cross-clamping using parallel perfusion. PV ablation on both sides, RA ablation, and LAA occlusion by surgical endostapler. After the ablation step, blood cardioplegia and coronary artery bypass grafting were performed.
RESULTS:. Group 2 (CABG+ Cox Maze V) differed from group 1 (CABG+RFA LV) in the operation time (330 vs 255 min, р=0,0001), CPB time (131 vs 89 min, р=0,0001), time of ablation (53 vs 10 min, р=0,0001). The type and frequency of complications were statistically comparable. Significantly lower rates of AF/AFL recurrence were observed in group II (13,3% vs 33,3%, p=0,044). Sinus rhythm was restored in all cases. Incidence of transient (less than 7 days) sinus dysfunction was 6,7% and 16,6% (р=0,128), in groups 1 and 2, respectively. In 12 months, cumulative freedom from AF/AFL/AAT without AAMT was reliably higher in II group comparing with I group: 97% vs 83,5% (р=0,020). Freedom from MACCE was 96,7% in both groups.
CONCLUSIONS:. Cox Maze V procedure in concomitant paroxysmal AF, increased the CPB time and operation time, but generally, didn’t negativelly impact the postoperative period and showed safety of the technique. On the other hand, simultaneous CABG with Cox Maze V procedure significantly reduced the incidence of arrhythmia recurrence comparing with RFA PV both at in-hospital and medium-long term follow up, that makes it a reasonable option for patients with paroxysmal AF and a high risk of POAF.
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