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Concomitant Midcab Surgery And Thoracoscopic Epicardial Dallas Lesion Set Ablation
Pavel A. Shilenko, Yurii Schneider, Men De Tsoy, Mikhail Fomenko;
FCSSH 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? Have to we perform sternotomy? Coronary artery bypass grafting and pulmonary vein isolation with bipolar clamp? If needed only MIDCAB surgery. Or on pump 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 seven years, we performed 16 MIDCAB (LIMA-LAD, LIMA-DA-LAD) combination with thoracoscopic epicardial ablation at once. In all cases, the ablation «Dallas» lesion set and left atrial appendage ligation was performed. All operations performed according to the scheme: thoracoscopic ablation with LAAL at first and then, MIDCAB. In 2 cases, were performed sequential CABG LIMA-DA-LAD. 6 patients had a long-standing persistent atrial fibrillation. 10 were male. The average age 64 years (54-81). 14 patients had isolated proximal LAD disease. 2 had LAD and DA disease.
RESULTS:The operation time was 212 min (+- 24min). The average time of ablation was 132 minutes (- +18 min). In 3 operations sinus rhythm was restored without cardioversion. Complications such as heart attack and bleeding are not noted. Intensive care unit time was 18 hours (- +3.2). In 12 cases, freedom from atrial fibrillation was confirmed after 3 year. Catheter re-isolation performed in one patient with atrial flutter. There was no need for coronary reintervention.
CONCLUSIONS:The accumulated experience of performing thoracoscopic ablation can be successfully used in patients with coronary disease. We can use different types minimally invasive surgery for patient with coronary disease and AF.
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