Charlotte van Laar1, Mohamed Bentala2, Timo Weimar3, Nicolas Doll3, Martin J Swaans4, Sander G Molhoek5, Frederik N Hofman1, Johannes Kelder6, Bart P van Putte1,7. 1. Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands. 2. Department of Cardiothoracic Surgery, Amphia Hospital, Molengracht 21, CK Breda, the Netherlands. 3. Sana HerzchirurgischeKlinik Stuttgart GmbH, Department of Cardiac Surgery, Herdweg 2, Stuttgart, Baden-Württemberg, Germany. 4. Department of Cardiology, St. Antonius Hospital, Koekoekslaan 1, CM Nieuwegein, the Netherlands. 5. Department of Cardiology, Amphia Hospital, Molengracht 21, CK Breda, the Netherlands. 6. St. Antonius Hospital, Department of Research & Development, Koekoekslaan 1, CM Nieuwegein, the Netherlands. 7. Department of Cardiothoracic Surgery, Academic Medical Center, Meibergdreef 9, AZ Amsterdam, the Netherlands.
Abstract
AIMS: To perform a systematic outcome analysis in order to provide cardiologists and general pactitioners with more adequate information to guide their decision making regarding rhythm control. Totally thoracoscopic maze (TTmaze) for the treatment of atrial fibrillation (AF) is recommended as a Class 2a indication mainly based on single centre studies including small patient cohorts and inconsistent lesion sets. METHODS AND RESULTS: We studied consecutive patients undergoing TTmaze in three European referral centres (2012-15). Primary outcome was freedom from atrial tachyarrhythmia (ATA). Secondary outcomes were 30-day complications, the composite endpoint of ischaemic stroke, haemorrhagic stroke or transient ischaemic attack (TIA), all-cause mortality, and predictors of ATA recurrence. Four hundred and seventy-five patients were included, with a mean age of 61 ± 9 years and 69.5% male. The mean CHA2DS2-VASc score was 1.7 ± 1.3. The overall freedom from ATA was 68.8% after a mean follow-up period of 20 ± 9 months. Freedom from ATA was 72.7% for paroxysmal AF, 68.9% for persistent AF, and 54.2% for longstanding persistent AF. Multivariate analysis revealed female gender [hazard ratio (HR): 1.87, P = 0.005], in-hospital AF (HR: 1.95, P = 0.040), longer duration of preoperative AF (HR: 1.06, P = 0.003) and mitral regurgitation (HR: 1.84, P = 0.025) as independent predictors of ATA recurrence. Overall 30-day freedom from any complication was 92.4%. Freedom from cerebrovascular events after mean follow-up of 30 ± 16 months was 98.7% and overall survival was 98.3%. The observed rate of ischaemic stroke, haemorrhagic stroke, or TIA was low (0.5 per 100 patient-years). CONCLUSION: Totally thoracoscopic maze is a safe and effective rhythm control therapy. Published on behalf of the European Society of Cardiology. All rights reserved.
AIMS: To perform a systematic outcome analysis in order to provide cardiologists and general pactitioners with more adequate information to guide their decision making regarding rhythm control. Totally thoracoscopic maze (TTmaze) for the treatment of atrial fibrillation (AF) is recommended as a Class 2a indication mainly based on single centre studies including small patient cohorts and inconsistent lesion sets. METHODS AND RESULTS: We studied consecutive patients undergoing TTmaze in three European referral centres (2012-15). Primary outcome was freedom from atrial tachyarrhythmia (ATA). Secondary outcomes were 30-day complications, the composite endpoint of ischaemic stroke, haemorrhagic stroke or transient ischaemic attack (TIA), all-cause mortality, and predictors of ATA recurrence. Four hundred and seventy-five patients were included, with a mean age of 61 ± 9 years and 69.5% male. The mean CHA2DS2-VASc score was 1.7 ± 1.3. The overall freedom from ATA was 68.8% after a mean follow-up period of 20 ± 9 months. Freedom from ATA was 72.7% for paroxysmal AF, 68.9% for persistent AF, and 54.2% for longstanding persistent AF. Multivariate analysis revealed female gender [hazard ratio (HR): 1.87, P = 0.005], in-hospital AF (HR: 1.95, P = 0.040), longer duration of preoperative AF (HR: 1.06, P = 0.003) and mitral regurgitation (HR: 1.84, P = 0.025) as independent predictors of ATA recurrence. Overall 30-day freedom from any complication was 92.4%. Freedom from cerebrovascular events after mean follow-up of 30 ± 16 months was 98.7% and overall survival was 98.3%. The observed rate of ischaemic stroke, haemorrhagic stroke, or TIA was low (0.5 per 100 patient-years). CONCLUSION: Totally thoracoscopic maze is a safe and effective rhythm control therapy. Published on behalf of the European Society of Cardiology. All rights reserved.
Authors: Niels Harlaar; Maurice A Oudeman; Serge A Trines; Gijsbert S de Ruiter; Bart J Mertens; Muchtair Khan; Robert J M Klautz; Katja Zeppenfeld; Andrew Tjon; Jerry Braun; Thomas J van Brakel Journal: Interact Cardiovasc Thorac Surg Date: 2022-06-01