Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands.
Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands.
Eur J Cardiothorac Surg. 2022 Oct 4;62(5). doi: 10.1093/ejcts/ezac409.
Thoracoscopic ablation for atrial fibrillation (AF) and minimally invasive direct coronary artery bypass (MIDCAB) with robot-assisted left internal mammary artery (LIMA) harvesting may represent a safe and effective alternative to more invasive surgical approaches via sternotomy. The aim of our study was to describe the feasibility, safety and efficacy of a unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB surgery.
Retrospective analysis of a prospectively gathered cohort was performed of all consecutive patients with AF and at least a critical left anterior descending artery (LAD) stenosis that underwent unilateral left-sided thoracoscopic AF ablation and concomitant off-pump MIDCAB surgery in the Maastricht University Medical Centre between 2017 and 2021.
Twenty-three patients were included [age 69 years (standard deviation = 8), paroxysmal AF 61%, left atrial volume index 42 ml/m2 (standard deviation = 11)]. Unilateral left-sided thoracoscopic isolation of the left (n = 23) and right (n = 22) pulmonary veins and box (n = 21) by radiofrequency ablation was succeeded by epicardial validation of exit- and entrance block (n = 22). All patients received robot-assisted LIMA harvesting and off-pump LIMA-LAD anastomosis through a left mini-thoracotomy. The perioperative complications consisted of one bleeding of the thoracotomy wound and one aborted myocardial infarction not requiring intervention. The mean duration of hospital stay was 6 days (standard deviation = 2). After discharge, cardiac hospital readmission occurred in 4 patients (AF n = 1; pleural- and pericardial effusion n = 2, myocardial infarction requiring the percutaneous intervention of the LIMA-LAD n = 1) within 1 year. After 12 months, 17/21 (81%) patients were in sinus rhythm when allowing anti-arrhythmic drugs. Finally, the left atrial ejection fraction improved postoperatively [26% (standard deviation = 11) to 38% (standard deviation = 7), P = 0.01].
In this initial feasibility and early safety study, unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB for LIMA-LAD grafting is a feasible, safe and efficacious for patients with AF and a critical LAD stenosis.
胸腔镜消融术治疗心房颤动（AF）和微创直接冠状动脉旁路移植术（MIDCAB）联合机器人辅助左内乳动脉（LIMA）采集术可能代表了一种比经胸骨切开术更具侵袭性的手术方法更安全有效的替代方法。我们的研究目的是描述单侧左侧胸腔镜 AF 消融术和同时进行的非体外循环 MIDCAB 手术的可行性、安全性和疗效。
回顾性分析了 2017 年至 2021 年期间在马斯特里赫特大学医学中心接受单侧左侧胸腔镜 AF 消融术和非体外循环 MIDCAB 手术的同时伴有至少临界左前降支（LAD）狭窄的 AF 患者的前瞻性收集队列的连续患者。
共纳入 23 例患者[年龄 69 岁（标准差=8），阵发性 AF 61%，左心房容积指数 42ml/m2（标准差=11）]。通过射频消融术成功进行了左侧（n=23）和右侧（n=22）肺静脉和盒式（n=21）的单侧左侧胸腔镜隔离，随后进行了心外膜验证的出口和入口阻滞（n=22）。所有患者均通过左侧小切口接受机器人辅助 LIMA 采集和非体外循环 LIMA-LAD 吻合术。围手术期并发症包括一例开胸伤口出血和一例不需要介入治疗的心肌梗死。平均住院时间为 6 天（标准差=2）。出院后，4 例患者在 1 年内再次入住心脏医院（AF n=1；胸腔和心包积液 n=2，需要经皮干预 LIMA-LAD 的心肌梗死 n=1）。12 个月后，17/21（81%）例患者允许使用抗心律失常药物时处于窦性节律。最后，左心房射血分数术后改善[26%（标准差=11）至 38%（标准差=7），P=0.01]。
在这项初步可行性和早期安全性研究中，单侧左侧胸腔镜 AF 消融术联合 MIDCAB 用于 LIMA-LAD 搭桥术对于 AF 合并临界 LAD 狭窄的患者是一种可行、安全和有效的方法。
