Tiwari Kaushal Kishore, Gasbarri Tommaso, Bevilacqua Stefano, Glauber Mattia
Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy; Department of Cardiothoracic and Vascular Surgery, College of Medical Sciences, Teaching Hospital, Kathmandu University, Bharatpur, Nepal.
Department of Adult Cardiac Surgery, G. Pasquinucci Heart Hospital, Massa, Italy.
Res Cardiovasc Med. 2016 Mar 5;5(2):e31374. doi: 10.5812/cardiovascmed.31374. eCollection 2016 May.
Atrial fibrillation (AF) is the most common arrhythmia diagnosed in humans and therefore causes a high socioeconomic burden. The Cox-Maze IV procedure is the gold standard treatment for atrial fibrillation. Minimally invasive surgery for the treatment of AF is also promising.
Our aim is to evaluate the feasibility, safety, and immediate plus medium-term results of concomitant AF ablation therapy in patients undergoing minimally invasive valve surgery through right-sided minithoracotomy.
Retrospective data were collected from January 2012 to December 2013. Seventy-five consecutive patients underwent radiofrequency ablation during valve surgery through a right-sided minithoracotomy.
All 75 patients underwent radiofrequency ablation. The pulmonary vein was isolated in 6 (8%) by encircling the left and right pulmonary veins. In 9 (12%) patients, endocardial box lesions were created using a monopolar probe, while in 47 (62.7%), epicardial box lesions were produced with a monopolar probe. Thirteen (17.3%) patients received a box lesion created with a bipolar probe. Finally, in 22 (29.3%) patients, a line of lesions was produced leading up to the posterior mitral annulus. Only 1 (1.3%) perioperative death was observed. At discharge, 43 (57.3%) patients were in sinus rhythm and 30 (40%) were in AF. After a mean follow-up of 21.6 ± 10.1 months, 46 patients (63%) were in a stable sinus rhythm and 27 were in (37%) in AF; 26 (56.5%) patients were free from antiarrhythmic therapy, while 19 (42.2%) were still taking at least one drug.
We can conclude that treatment of AF using a right-sided minithoracotomy approach and RF energy in patients undergoing cardiac surgery for various valve diseases is feasible, safe, and reproducible.
心房颤动（AF）是人类诊断出的最常见心律失常，因此造成了高昂的社会经济负担。Cox-Maze IV手术是心房颤动的金标准治疗方法。微创外科手术治疗心房颤动也很有前景。
我们的目的是评估通过右侧小切口进行微创瓣膜手术的患者同时进行房颤消融治疗的可行性、安全性以及近期和中期结果。
收集2012年1月至2013年12月的回顾性数据。75例连续患者在瓣膜手术期间通过右侧小切口接受了射频消融。
所有75例患者均接受了射频消融。通过环绕左右肺静脉，6例（8%）患者实现了肺静脉隔离。9例（12%）患者使用单极探头创建了心内膜盒状损伤，而47例（62.7%）患者使用单极探头产生了心外膜盒状损伤。13例（17.3%）患者接受了双极探头创建的盒状损伤。最后，22例（29.3%）患者产生了通向二尖瓣后环的损伤线。仅观察到1例（1.3%）围手术期死亡。出院时，43例（57.3%）患者为窦性心律，30例（40%）为房颤。平均随访21.6±10.1个月后，46例患者（63%）为稳定窦性心律，27例（37%）为房颤；26例（56.5%）患者无需抗心律失常治疗，而19例（42.2%）仍至少服用一种药物。
我们可以得出结论，对于因各种瓣膜疾病接受心脏手术的患者，采用右侧小切口入路和射频能量治疗房颤是可行、安全且可重复的。
