Huiming Guo1, Hongkun Qing1, Yuyuan Zhang1, Jian Liu1, Zhao Chen1, Zhongming Cao1, Jindong Xu1, Huanlei Huang1, Yumei Xue2, Xianzhang Zhan2, Fangzhou Liu2, Shulin Wu2, Jian Zhuang1. 1. Department of Cardiac Surgery, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong Provincial Key Laboratory of South China Structural Heart Disease, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China. 2. Department of Cardiology, Atrial Fibrillation Center, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou 510080, China.
Abstract
BACKGROUND: To explore an effective, reproducible and less invasive surgical approach for lone atrial fibrillation (AF). METHODS: A modified "mini-maze" including pulmonary vein isolation (PVI), box-lesion and left atrial appendage (LAA) resection was applied for AF patients in our center from January 2016 to June 2017. A 2.5 cm thoracotomy extended with tissue retractor was made as working port in the fourth intercostal space on each anterior side of the chest. The thoracoscope was inserted in another port lateral to main port for observing. During PVI, the tip of the clamp could be adjusted to reach as superior as the roof of left atrium for transmural lesions. The floor line was made by linear ablation pen. The LAA was removed by stapler before PVI for better exposure of the roof. RESULTS: This modified "mini-maze" was successfully completed in 53 non-paroxysmal AF patients except 1 was converted to sternotomy due to intraoperative hemorrhage. All patients recovered uneventfully. Seven-day Holter was accessed in 3, 6 and 12 months respectively in all patients. The mean follow-up was 14 (range, 3-30) months. Sinus rhythm was achieved in 48.1%, 64.8% before discharge and 3 months after surgery respectively, Twenty-eight patients in sinus rhythm or not, underwent catheter mapping and ablation three months after the operation to conform the lesion set made by this procedure. Sinus rhythm reached 87.0% after subsequent catheter ablation without any anti-arrhythmia treatment at 12 months. All patients survived without stroke, hemorrhage and pulmonary vein stenosis. CONCLUSIONS: Modified "mini-maze" procedure is safe, less invasive and highly reproducible for lone AF. Sequential hybrid procedure will shape the treatment of non-paroxysmal AF.
BACKGROUND: To explore an effective, reproducible and less invasive surgical approach for lone atrial fibrillation (AF). METHODS: A modified "mini-maze" including pulmonary vein isolation (PVI), box-lesion and left atrial appendage (LAA) resection was applied for AF patients in our center from January 2016 to June 2017. A 2.5 cm thoracotomy extended with tissue retractor was made as working port in the fourth intercostal space on each anterior side of the chest. The thoracoscope was inserted in another port lateral to main port for observing. During PVI, the tip of the clamp could be adjusted to reach as superior as the roof of left atrium for transmural lesions. The floor line was made by linear ablation pen. The LAA was removed by stapler before PVI for better exposure of the roof. RESULTS: This modified "mini-maze" was successfully completed in 53 non-paroxysmal AF patients except 1 was converted to sternotomy due to intraoperative hemorrhage. All patients recovered uneventfully. Seven-day Holter was accessed in 3, 6 and 12 months respectively in all patients. The mean follow-up was 14 (range, 3-30) months. Sinus rhythm was achieved in 48.1%, 64.8% before discharge and 3 months after surgery respectively, Twenty-eight patients in sinus rhythm or not, underwent catheter mapping and ablation three months after the operation to conform the lesion set made by this procedure. Sinus rhythm reached 87.0% after subsequent catheter ablation without any anti-arrhythmia treatment at 12 months. All patients survived without stroke, hemorrhage and pulmonary vein stenosis. CONCLUSIONS: Modified "mini-maze" procedure is safe, less invasive and highly reproducible for lone AF. Sequential hybrid procedure will shape the treatment of non-paroxysmal AF.
Authors: Randall K Wolf; E William Schneeberger; Robert Osterday; Doug Miller; Walter Merrill; John B Flege; A Marc Gillinov Journal: J Thorac Cardiovasc Surg Date: 2005-09 Impact factor: 5.209
Authors: Carlo de Asmundis; Gian-Battista Chierchia; Giacomo Mugnai; Ines Van Loo; Jan Nijs; Jens Czapla; Giulio Conte; Vedran Velagic; Moises Rodrigues Mañero; Giuseppe Ciconte; Erwin Ströker; Vincent Umbrain; Jan Poelaert; Pedro Brugada; Mark La Meir Journal: Europace Date: 2016-05-31 Impact factor: 5.214
Authors: Laurent Pison; Mark La Meir; Jurren van Opstal; Yuri Blaauw; Jos Maessen; Harry J Crijns Journal: J Am Coll Cardiol Date: 2012-07-03 Impact factor: 24.094
Authors: Paulus Kirchhof; Stefano Benussi; Dipak Kotecha; Anders Ahlsson; Dan Atar; Barbara Casadei; Manuel Castella; Hans-Christoph Diener; Hein Heidbuchel; Jeroen Hendriks; Gerhard Hindricks; Antonis S Manolis; Jonas Oldgren; Bogdan Alexandru Popescu; Ulrich Schotten; Bart Van Putte; Panagiotis Vardas Journal: Eur Heart J Date: 2016-08-27 Impact factor: 29.983
Authors: Lucas V A Boersma; Manuel Castella; Wimjan van Boven; Antonio Berruezo; Alaaddin Yilmaz; Mercedes Nadal; Elena Sandoval; Naiara Calvo; Josep Brugada; Johannes Kelder; Maurits Wijffels; Lluís Mont Journal: Circulation Date: 2011-11-14 Impact factor: 29.690
Authors: J L Cox; R B Schuessler; H J D'Agostino; C M Stone; B C Chang; M E Cain; P B Corr; J P Boineau Journal: J Thorac Cardiovasc Surg Date: 1991-04 Impact factor: 5.209
Authors: Tommy Andersson; Anders Magnuson; Ing-Liss Bryngelsson; Ole Frøbert; Karin M Henriksson; Nils Edvardsson; Dritan Poçi Journal: Eur Heart J Date: 2013-01-14 Impact factor: 29.983