University Hospital of Brussels, Belgium and University Hospital Maastricht, The Netherlands.
Ann Cardiothorac Surg. 2014 Jan;3(1):30-7. doi: 10.3978/j.issn.2225-319X.2014.01.07.
If we want to improve the outcomes, increase the success and reduce the complication rate of existing treatment strategies in concomitant and stand-alone atrial fibrillation (AF) procedures, we will have to increase our understanding of the pathophysiology, and of the disease, the limitations of current energy sources and ablation catheters, the different possible lesion sets, as well as improve communication between the electrophysiologist and cardiac surgeon. The technical limitations of percutaneous endocardial ablation procedures and the empirical techniques in surgical AF procedures necessitate new and innovative approaches. Surgeons should aim to improve the quality of the lesion set and minimize the invasiveness of existing techniques. The Maze procedure remains the basis upon which most of the more limited concomitant ablation procedures are and will be designed, but in stand-alone patients, recent progress has directed us towards either a single-step or sequential combined percutaneous endocardial procedure with a thoracoscopic epicardial procedure on the beating heart. A dedicated team of electrophysiologists and cardiothoracic surgeons can now work together to perform AF procedures. This can guide us to determine if there is an additional value of limiting the lesion set of the Maze procedure in concomitant surgery, and of an epicardial access in the treatment of stand-alone AF on the beating heart. If so, we will better understand which energy sources, lesion sets and surgical techniques are able to give us a three-dimensional knowledge and a three-dimensional treatment of AF. As a result, we can expect to obtain a higher single procedure long-term success rate with an acceptable low complication rate.
如果我们想提高现有治疗策略在合并和独立房颤（AF）手术中的疗效、成功率并降低并发症发生率，我们将不得不加深对病理生理学和疾病的理解，认识到当前能量源和消融导管的局限性、不同的可能损伤部位，并改善电生理学家和心脏外科医生之间的沟通。经皮心内膜消融程序的技术局限性和外科 AF 程序中的经验性技术需要新的创新方法。外科医生应致力于提高损伤部位的质量，并将现有技术的侵袭性降至最低。迷宫手术仍然是大多数更有限的合并消融程序的基础，并且将基于此设计，但对于独立患者，最近的进展已引导我们采用单次或序贯联合经皮心内膜程序，并在跳动心脏上行胸腔镜下心外膜程序。现在，一支专门的电生理学家和心胸外科医生团队可以共同进行 AF 手术。这可以帮助我们确定在合并手术中限制迷宫手术的损伤部位以及在跳动心脏上行心外膜介入治疗独立 AF 是否具有额外价值。如果有，我们将更好地理解哪些能量源、损伤部位和外科技术能够为我们提供 AF 的三维知识和三维治疗。因此，我们有望获得更高的单次手术长期成功率，并保持可接受的低并发症发生率。
