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Van Gelder IC, Rienstra M, Bunting KV, Casado-Arroyo R, Caso V, Crijns HJGM, De Potter TJR, Dwight J, Guasti L, Hanke T, Jaarsma T, Lettino M, Løchen ML, Lumbers RT, Maesen B, Mølgaard I, Rosano GMC, Sanders P, Schnabel RB, Suwalski P, Svennberg E, Tamargo J, Tica O, Traykov V, Tzeis S, Kotecha D. 2024 ESC Guidelines for the management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J 2024; 45:3314-3414. [PMID: 39210723 DOI: 10.1093/eurheartj/ehae176] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024] Open
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Vos LM, Vos R, Nieuwkerk PT, Vos PPWK, Hofman FN, Klautz RJM, Van Putte BP. Quality of life improvement from thoracoscopic atrial fibrillation ablation in women versus men: a prospective cohort study. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 39:ivae132. [PMID: 38991842 PMCID: PMC11268440 DOI: 10.1093/icvts/ivae132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Accepted: 07/10/2024] [Indexed: 07/13/2024]
Abstract
OBJECTIVES Thoracoscopic ablation has proven to be an effective and safe rhythm control strategy, especially for persistent atrial fibrillation. However, its impact on quality of life (QoL) and potential gender differences remains unclear. METHODS This prospective, single-centre observational study included consecutive patients with symptomatic atrial fibrillation undergoing thoracoscopic ablation. QoL was measured using the Short Form 36 (SF-36) and Atrial Fibrillation Effect on Quality-of-Life (AFEQT) questionnaires and longitudinal trend analysis including linear mixed models was used to assess gender-specific differences. RESULTS A total of 191 patients were included; mean age 63.9 ± 8.6 years, 61 (31.9%) women and 148 (77.5%) with non-paroxysmal atrial fibrillation. Women were older, more symptomatic and reported lower baseline QoL. AFEQT summary scores substantially improved after three months (relative increase 51.5% from baseline; P < 0.001) and persisted up to 1-year (57.2%; P < 0.001). Women showed substantial QoL improvement, which was comparable to men at 1 year. Distinct gender-related trajectories for AFEQT were observed. Women showed more often clinically important decline over time, yet AF recurrence and age were predictive factors in both men and women. Patients with AF recurrence also experienced QoL improvements, albeit to a lesser extent than those in sinus rhythm (61.3% vs 26.9%, P < 0.001), with no differences between men and women. CONCLUSIONS Thoracoscopic ablation for atrial fibrillation results in substantial QoL improvement and was comparable for men and women. Understanding sex-specific and age-related trajectories is important to further enhance patient-centred atrial fibrillation care.
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Affiliation(s)
- Lara M Vos
- Department of Cardiothoracic Surgery, Erasmus Medical Center, Rotterdam, the Netherlands
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Rein Vos
- Department of Methodology and Statistics, CAPHRI School for Public Health and Primary Care, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Pythia T Nieuwkerk
- Department of Medical Psychology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- Amsterdam Institute for Infection and Immunity, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Peter-Paul W K Vos
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Frederik N Hofman
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
| | - Robert J M Klautz
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
| | - Bart P Van Putte
- Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, the Netherlands
- Department of Cardiothoracic Surgery, Amsterdam University Medical Centers, Amsterdam, the Netherlands
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van der Heijden CAJ, Adriaans BP, van Kuijk SMJ, Luermans JGLM, Chaldoupi SM, Maessen JG, Bidar E, Maesen B. Left atrial function of patients with atrial fibrillation undergoing thoracoscopic hybrid ablation. INTERDISCIPLINARY CARDIOVASCULAR AND THORACIC SURGERY 2024; 38:ivae061. [PMID: 38569919 PMCID: PMC11043019 DOI: 10.1093/icvts/ivae061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVES Thoracoscopic hybrid ablation is an effective and safe rhythm control strategy for patients with complex forms of atrial fibrillation. Its effect on left atrial function has not yet been studied. METHODS In a retrospective single-centre analysis of patients undergoing thoracoscopic hybrid ablation, the left atrial emptying fraction was calculated using the biplane modified Simpson method in the apical 2- and 4-chamber views on transthoracic echocardiography. Left atrial strain (reservoir, conduction and contractility) was quantified using dedicated software. RESULTS Sixty-seven patients were included (mean age 64 years, long-standing persistent atrial fibrillation in 69%, median atrial fibrillation history duration 64 months). At baseline, left atrial function and contractility were poor. The reservoir and contractile strain improved postprocedure compared to baseline [15 (standard deviation (SD): 8) and 17 (SD: 6); P = 0.013; 3 (SD: 5) and 4 (SD: 4), P = 0.008], whereas the left atrial volume indexed to the body surface area was reduced [51 ml/m2 (SD: 14) and 47 ml/m2 (SD: 18), P = 0.0024]. In patients with preoperative (long-standing) persistent atrial fibrillation and in patients with rhythm restoration, improvements in the emptying fraction, (reservoir and contractile) strain and the left ventricular ejection fraction were observed, whereas the left atrial volume decreased (P < 0.05). CONCLUSIONS In this cohort of patients with severely diseased left atria, improvement in left atrial contractility and in the emptying fraction after thoracoscopic hybrid ablation for atrial fibrillation in patients with persistent atrial fibrillation is mainly due to rhythm restoration. Interestingly, the procedure itself also results in improved left atrial reservoir strain and reversed left atrial remodelling by reducing left atrial volume.
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Affiliation(s)
| | - Bouke P Adriaans
- Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Sevasti-Marisevi Chaldoupi
- Department of Cardiology, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, the Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht, Netherlands
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Tjon Joek Tjien A, Akca F, Lam K, Olsthoorn J, Dekker L, van der Voort P, Verberkmoes N, van Brakel TJ. Concomitant atrial fibrillation ablation in minimally invasive cardiac surgery. Ann Cardiothorac Surg 2024; 13:91-98. [PMID: 38380139 PMCID: PMC10875199 DOI: 10.21037/acs-2023-afm-21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 11/23/2023] [Indexed: 02/22/2024]
Abstract
Concomitant atrial fibrillation (AF) ablation in cardiac surgery effectively restores sinus rhythm and may reduce morbidity and mortality. Cardiac surgery has witnessed the transition from the historical Cox Maze procedure to more modern and less invasive approaches for concomitant AF treatment. As minimally invasive cardiac surgery gains traction, ablation methods and careful patient selection become crucial to optimize results. Emerging techniques, including bipolar epicardial radiofrequency and endo/epicardial cryoablation, are central to these advances, targeting specific arrhythmogenic areas within the atria. While pulmonary vein isolation (PVI) is essential, it may be insufficient for patients with persistent or longstanding persistent AF. In such cases, left atrial posterior wall isolation has proven beneficial. Furthermore, recent studies emphasize the significance of left atrial appendage occlusion in concurrent AF treatments, highlighting its role in stroke risk reduction. Notably, the left atrium remains the focal point for concomitant AF surgery over the right, primarily due to concerns like high pacemaker implantation rates and complexities of right atrial ablation sets. Although guidelines support its widespread use, concomitant AF ablation outcomes vary based on patient selection, surgeon's expertise, and clinical context and thus the Heart Team's input is crucial for individualized decisions. In the upcoming sections, we present our patient selection and a visual guide to our techniques for concomitant AF surgery in minimally invasive mitral valve, coronary artery bypass and aortic valve surgery.
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Affiliation(s)
- Andrew Tjon Joek Tjien
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Ferdi Akca
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Kayan Lam
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Jules Olsthoorn
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Lukas Dekker
- Department of Cardiology, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
- Department of Biomedical Technology, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Pepijn van der Voort
- Department of Cardiology, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Niels Verberkmoes
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
| | - Thomas J. van Brakel
- Department of Cardiothoracic Surgery, Heart Center, Catharina Hospital, Eindhoven, The Netherlands
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Kumar NS, Khanji MY, Patel KP, Ricci F, Providencia R, Chahal A, Sohaib A, Awad WI. Surgical management of atrial fibrillation in patients undergoing cardiac surgery: a systematic review of clinical practice guidelines and recommendations. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2024; 10:14-24. [PMID: 37873664 DOI: 10.1093/ehjqcco/qcad060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 09/20/2023] [Accepted: 10/20/2023] [Indexed: 10/25/2023]
Abstract
AIMS Surgical ablation of atrial fibrillation (AF) has been demonstrated to be a safe procedure conducted concomitantly alongside cardiac surgery. However, there are conflicting guideline recommendations surrounding indications for surgical ablation. We conducted a systematic review of current recommendations on concomitant surgical AF ablation. METHODS AND RESULTS We identified publications from MEDLINE and EMBASE between January 2011 and December 2022 and additionally searched Guideline libraries and websites of relevant organizations in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Of 895 studies screened, 4 were rigorously developed (AGREE-II > 50%) and included. All guidelines agreed on the definitions of paroxysmal, persistent, and longstanding AF based on duration and refraction to current treatment modalities. In the Australia-New Zealand (CSANZ) and European (EACTS) guidelines, opportunistic screening for patients >65 years is recommended. The EACTS recommends systematic screening for those aged >75 or at high stroke risk (Class IIa, Level B). However, this was not recommended by American Heart Association or Society of Thoracic Surgeons guidelines. All guidelines identified surgical AF ablation during concomitant cardiac surgery as safe and recommended for consideration by a Heart Team with notable variation in recommendation strength and the specific indication (three guidelines fail to specify any indication for surgery). Only the STS recommended left atrial appendage occlusion (LAAO) alongside surgical ablation (Class IIa, Level C). CONCLUSION Disagreements exist in recommendations for specific indications for concomitant AF ablation and LAAO, with the decision subject to Heart Team assessment. Further evidence is needed to develop recommendations for specific indications for concomitant AF procedures and guidelines need to be made congruent.
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Affiliation(s)
- Niraj S Kumar
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- National Medical Research Association, London, UK
| | - Mohammed Y Khanji
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Newham University Hospital, Barts Health NHS Trust, London, UK
- NIHR Barts Biomedical Research Centre, William Harvey Research Institute, Queen Mary University of London, London, UK
| | - Kush P Patel
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Institute of Cardiovascular Sciences, University College London, UK
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, G.d'Annunzio University of Chieti-Pescara, Chieti, Italy
| | - Rui Providencia
- Department of Cardiac Electrophysiology, Barts Heart Centre, St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - Anwar Chahal
- Division of Cardiology, Hospital of the University of Pennsylvania, Philadelphia, PA, USA
| | | | - Wael I Awad
- Barts Heart Centre, St. Bartholomew's Hospital, London, UK
- Centre for Cardiovascular Medicine and Devices, William Harvey Research Institute, Queen Mary University of London, London, UK
- University of South Wales, Cardiff, UK
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Nitta T, Wai JWW, Lee SH, Yii M, Chaiyaroj S, Ruaengsri C, Ramanathan T, Ishii Y, Jeong DS, Chang J, Hardjosworo ABA, Imai K, Shao Y. 2023 APHRS expert consensus statements on surgery for AF. J Arrhythm 2023; 39:841-852. [PMID: 38045465 PMCID: PMC10692856 DOI: 10.1002/joa3.12939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/14/2023] [Accepted: 10/02/2023] [Indexed: 12/05/2023] Open
Affiliation(s)
| | | | - Seung Hyun Lee
- Cardiovascular SurgeryYonsei University College of MedicineSeoulSouth Korea
| | - Michael Yii
- Cardiothoracic Surgery, Epworth Eastern Hospital, and St Vincent's Hospital MelbourneUniversity of MelbourneMelbourneVictoriaAustralia
| | | | | | | | - Yosuke Ishii
- Cardiovascular SurgeryNippon Medical SchoolTokyoJapan
| | - Dong Seop Jeong
- Thoracic and Cardiovascular Surgery, Samsung Medical CenterSungkyunkwan University School of MedicineSeoulSouth Korea
| | - Jen‐Ping Chang
- Thoracic and Cardiovascular SurgeryKaohsiung Chang Gung Memorial HospitalKaohsiungTaiwan
| | | | - Katsuhiko Imai
- Heart Center of National Hospital Organization Kure Medical Center and Chugoku Cancer CenterKure, HiroshimaJapan
| | - Yongfeng Shao
- Cardiovascular Surgery, Jiangsu Province HospitalNanjing Medical UniversityNanjingChina
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Han E, Liu Z, Zhou B, Wang S, Hu Z, Cui Y. Application of Cut-and-Sew Technique in Thoracoscopic Minimally Invasive Mitral Valve Surgery and Concomitant Maze Procedure. Braz J Cardiovasc Surg 2023; 39:e20220456. [PMID: 37943994 PMCID: PMC10655133 DOI: 10.21470/1678-9741-2022-0456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2023] [Accepted: 06/05/2023] [Indexed: 11/12/2023] Open
Abstract
INTRODUCTION Atrial fibrillation is one of the common complications of mitral valve disease. Currently, in the absence of freezing equipment, it's still impossible to fully conduct a minimally invasive Cox-maze IV procedure to treat atrial fibrillation. METHODS We analyzed the clinical data of 28 patients who underwent thoracoscopic minimally invasive mitral valve full maze surgery in our hospital from October 2021 to September 2022; 13 patients were male and 15 were female, three suffered from paroxysmal atrial fibrillation, and 25 suffered from permanent atrial fibrillation; average age was 61.88±8.30 years, and mean preoperative left atrial diameter was 47.12±8.34 mm. Isolation of left atrial posterior wall (box lesion) was completed in all patients by cut-and-sew technique and bipolar clamp ablation. RESULTS For these subjects, the median cardiopulmonary bypass time was 169 (109.75-202.75) minutes, aortic cross-clamping time was 106 (77.75-125.50) minutes, and ventilator assistance time was 6.5 (0-10) hours. Among them, eight subjects had the endotracheal tubes removed immediately after surgical operation. Three subjects were in the blanking period; two subjects still had atrial fibrillation at three months after operation, one of whom resumed sinus rhythm after electrical cardioversion therapy; and all the remaining 23 subjects had sinus rhythm. CONCLUSION The minimally invasive cut-and-sew technique for electrical isolation of left pulmonary veins can improve sinus conversion rate of patients suffering from both mitral valve disease and atrial fibrillation. In selected subjects, it is safe and has good results in the short-term postoperative period.
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Affiliation(s)
- Erlei Han
- Department of Cardiovascular Surgery, Heart Center, Zhejiang
Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical
College, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhifang Liu
- Department of Cardiovascular Surgery, Heart Center, Zhejiang
Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical
College, Hangzhou, Zhejiang, People’s Republic of China
| | - Bing Zhou
- Department of Cardiovascular Surgery, Heart Center, Zhejiang
Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical
College, Hangzhou, Zhejiang, People’s Republic of China
| | - Shuwei Wang
- Department of Cardiovascular Surgery, Heart Center, Zhejiang
Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical
College, Hangzhou, Zhejiang, People’s Republic of China
| | - Zhibin Hu
- Department of Cardiovascular Surgery, Heart Center, Zhejiang
Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical
College, Hangzhou, Zhejiang, People’s Republic of China
| | - Yong Cui
- Department of Cardiovascular Surgery, Heart Center, Zhejiang
Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical
College, Hangzhou, Zhejiang, People’s Republic of China
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8
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van der Heijden CAJ, Weberndörfer V, Luermans JGLM, Chaldoupi SM, van Kuijk SMJ, Vroomen M, Bidar E, Maessen JG, Pison L, La Meir M, Maesen B. Hybrid ablation of atrial fibrillation: A unilateral left-sided thoracoscopic approach. J Card Surg 2022; 37:4630-4638. [PMID: 36349741 PMCID: PMC10099869 DOI: 10.1111/jocs.17144] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Hybrid ablation (HA) of atrial fibrillation (AF) combines minimally invasive thoracoscopic epicardial ablation with transvenous endocardial electrophysiologic validation and touch-up of incomplete epicardial lesions if needed. While studies have reported on a bilateral thoracoscopic HA approach, data on a unilateral left-sided approach are scarce. AIM To evaluate the efficacy and safety of a unilateral left-sided thoracoscopic approach. METHODS Retrospective analysis of a prospectively gathered cohort of all consecutive patients undergoing a unilateral left-sided HA for AF between 2015 and 2018 in the Maastricht University Medical Centre. RESULTS One-hundred nineteen patients were analyzed (mean age 64 ± 8, 28% female, mean body mass index 28 ± 4 kg/m2 , median CHA2 DS2 -VASc Score 2 [1-3], [longstanding]-persistent AF 71%, previous catheter ablation 44%). In all patients, a unilateral left-sided HA consisting of pulmonary vein (PV) isolation, posterior left atrial (LA) wall isolation, and LA appendage exclusion was attempted. Epicardial (n = 59) and/or endocardial validation (n = 81) was performed and endocardial touch-up was performed in 33 patients. Major peri-operative complications occurred in 5% of all patients. After 12 and 24 months, the probability of being free from supraventricular tachyarrhythmia recurrence was 80% [73-87] and 67% [58-76], respectively, when allowing antiarrhythmic drugs. CONCLUSION Unilateral left-sided hybrid AF ablation is an efficacious and safe approach to treat patients with paroxysmal and (longstanding) persistent AF. Future studies should compare a unilateral with a bilateral approach to determine whether a left-sided approach is as efficacious as a bilateral approach and allows for less complications.
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Affiliation(s)
- Claudia A J van der Heijden
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Vanessa Weberndörfer
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Justin G L M Luermans
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sevasti-Maria Chaldoupi
- Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands.,Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Mindy Vroomen
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
| | - Laurent Pison
- Department of Cardiology, Hospital East Limburg, Genk, Belgium
| | - Mark La Meir
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Department of Cardiac Surgery, UZ Brussel, Brussels, Belgium
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.,Cardiovascular Research Institute Maastricht, Maastricht, The Netherlands
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9
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van der Heijden CAJ, Segers P, Masud A, Weberndörfer V, Chaldoupi SM, Luermans JGLM, Bijvoet GP, Kietselaer BLJH, van Kuijk SMJ, Barenbrug PJC, Maessen JG, Bidar E, Maesen B. Unilateral left-sided thoracoscopic ablation of atrial fibrillation concomitant to minimally invasive bypass grafting of the left anterior descending artery. Eur J Cardiothorac Surg 2022; 62:ezac409. [PMID: 35947693 PMCID: PMC9531601 DOI: 10.1093/ejcts/ezac409] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES 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. METHODS 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. RESULTS 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]. CONCLUSIONS 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.
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Affiliation(s)
| | - Patrique Segers
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Anna Masud
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Vanessa Weberndörfer
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Sevasti-Marisevi Chaldoupi
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Justin G L M Luermans
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Geertruida P Bijvoet
- Department of Cardiology, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Bas L J H Kietselaer
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
- Department of Cardiology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center, Netherlands
| | - Paul J C Barenbrug
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
- Cardiovascular Research Institute Maastricht, Maastricht University, Maastricht, Netherlands
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10
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van der Heijden CAJ, Bidar E, Maesen B. Concomitant arrhythmia surgery should be a standard procedure in AF patients undergoing cardiac surgery. J Card Surg 2022; 37:3014-3015. [PMID: 35870184 PMCID: PMC9545281 DOI: 10.1111/jocs.16778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 07/06/2022] [Accepted: 07/06/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Claudia A. J. van der Heijden
- Department of Cardiothoracic Surgery Maastricht University Medical Centre Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht Maastricht University Maastricht The Netherlands
| | - Elham Bidar
- Department of Cardiothoracic Surgery Maastricht University Medical Centre Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht Maastricht University Maastricht The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery Maastricht University Medical Centre Maastricht The Netherlands
- Cardiovascular Research Institute Maastricht Maastricht University Maastricht The Netherlands
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