Suwalski Grzegorz, Emery Robert, Mróz Jakub, Kaczejko Kamil, Gryszko Leszek, Cwetsch Andrzej, Skrobowski Andrzej
Department of Cardiac Surgery, Military Institute of Medicine, Warsaw, Poland.
Department of Cardiac Surgery, St Joseph's Hospital, St. Paul, MN, USA.
Interact Cardiovasc Thorac Surg. 2017 Jun 1;24(6):823-827. doi: 10.1093/icvts/ivx026.
Concomitant surgical ablation of atrial fibrillation (AF) is recommended for patients undergoing off-pump coronary revascularization in the presence of this arrhythmia. Achievement of optimal visualization of pulmonary veins while maintaining stable haemodynamic conditions is crucial for proper completion of the ablation procedure. This study evaluates the safety and feasibility of right atrial positioning using a suction-based cardiac positioner as opposed to compressive manoeuvres for exposure during off-pump surgical ablation for AF.
Thirty-four consecutive patients underwent pulmonary vein isolation, ganglionated plexi ablation and left atrial appendage occlusion during off-pump coronary artery bypass grafting. Right atrial suction positioning was used to visualize right pulmonary veins. Safety and feasibility end points were analysed intraoperatively and in the early postoperative course.
In all patients, right atrial positioning created optimal conditions to complete transverse and oblique sinus blunt dissection, correct placement of a bipolar ablation probe, detection and ablation of ganglionated plexi and conduction block assessment. In all patients, this entire right-sided ablation procedure was completed with a single exposure manoeuvre. Feasibility end points were achieved in all study patients.
This report documents the safety and feasibility of right atrial exposure using a suction-based cardiac positioner to complete ablation for AF concomitant with off-pump coronary revascularization. This technique may be widely adopted to create stable haemodynamic conditions and optimal visualization of the right pulmonary veins.
对于在非体外循环冠状动脉血运重建术中合并心房颤动（AF）的患者，建议同时进行房颤手术消融。在维持稳定血流动力学条件的同时实现肺静脉的最佳可视化对于消融手术的顺利完成至关重要。本研究评估了在非体外循环房颤手术消融过程中，使用基于吸力的心脏定位器进行右心房定位以暴露肺静脉的安全性和可行性，而不是采用压迫手法。
34例连续患者在非体外循环冠状动脉搭桥术中接受了肺静脉隔离、神经节丛消融和左心耳封堵。使用右心房吸力定位来观察右肺静脉。在术中及术后早期对安全性和可行性终点进行分析。
在所有患者中，右心房定位创造了完成横窦和斜窦钝性分离、双极消融探头正确放置、神经节丛检测和消融以及传导阻滞评估的最佳条件。在所有患者中，整个右侧消融手术通过单次暴露操作完成。所有研究患者均达到了可行性终点。
本报告记录了使用基于吸力的心脏定位器进行右心房暴露以完成与非体外循环冠状动脉血运重建术相关的房颤消融的安全性和可行性。该技术可能会被广泛采用，以创造稳定的血流动力学条件并实现右肺静脉的最佳可视化。
