Results of Cryoablation for Atrial Fibrillation Concomitant With Video-Assisted Minimally Invasive Mitral Valve Surgery

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• 作者：Giovanni Marchetto ; MD ; PhD^* ; ^&dagger ; ; ^{giovanni.marchetto@libero.it} ; Matteo Anselmino ; MD ; PhD^&dagger ; ; Chiara Rovera ; MD^&dagger ; ; Samuel Mancuso ; MD^* ; ^&dagger ; ; Davide Ricci ; MD ; PhD^* ; ^&dagger ; ; Marina Antolini ; MD^&dagger ; ; Mara Morello ; MD^&dagger ; ; Fiorenzo Gaita ; MD^&dagger ; ; Mauro Rinaldi ; MD^* ; ^&dagger ;
• 关键词：atrial fibrillation ; minimally invasive mitral valve surgery ; surgical ablation ; Cryoablation atrial
• 刊名：Seminars in Thoracic and Cardiovascular Surgery
• 出版年：2016
• 出版时间：Summer 2016
• 年：2016
• 卷：28
• 期：2
• 页码：271-280
• 全文大小：1229 K
• 卷排序：28

文摘

Interest in minimally invasive video-assisted mitral valve surgery (MIMVS) is rapidly growing. Data on concomitant atrial fibrillation (AF) ablation to MIMVS are still lacking. The present study investigates the long-term results of AF cryoablation concomitant to MIMVS. From October 2006-September 2014, 68 patients with mitral valve disease (age 65.9 ± 11.1 years, 34 men out of 68 patients, Euroscore log 5.4 ± 4.5) and drug-resistant AF underwent MIMVS via right minithoracotomy and concomitant left-sided AF endocardial cryoablation (Cryoflex Medtronic, Minneapolis, MN). Patients were independently followed up by cardiological outpatient visits and underwent electrophysiological study when indicated. In total, 44 out of 68 patients (64.7%) underwent mitral valve repair and 8 patients (11.8%) also received concomitant tricuspid valve surgery. One procedure was electively converted to full sternotomy (1.5%). Total clamp time was 97.6 ± 22.8 minutes. In March 2015, 60 patients were alive and completed the follow-up after a mean of 3.4 ± 2.0 years following the procedure. In all, 48 patients (80%) presented sinus rhythm throughout the whole follow-up. Freedom from AF was respectively 95%, 87%, and 72% at 1, 3, and 5 years, respectively. We recorded 2 pacemaker implants (3.3%). A total of 3 patients suffered symptomatic recurrences (2 atypical atrial flutter and 1 atrial fibrillation) and underwent transcatheter ablation—all the 3 patients remained in stable sinus rhythm for the remaining follow-up. In conclusions, given the favorable long-term sinus rhythm maintenance rates of concomitant cryoablation, MIMVS can also be offered to patients with symptomatic AF. AF transcatheter ablation may easily avoid further symptomatic recurrences.