Port-access versus sternotomy for treatment of long-standing persistent rheumatic atrial fibrillation combined with mitral valve surgery

Objectives: To compare the efficiency of atrial fibrillation (AF) ablation combined with mitral valve (MV) surgery through port-access with through traditional approach. Methods: From July 2019 to October 2021, 81 patients with long-standing persistent rheumatic AF underwent biatrial ablation using monopolar radiofrequency devices combined with MV surgery. Patients were divided into two groups: sternotomy group (n=44) and totally endoscopic surgery (TES) group (n=37). Left atrial reduction was performed in all patients. The postoperative and follow-up results were analyzed and compared between the two groups. The mean follow-up times of the sternotomy and the TES groups were 22.2 ± 6.1 months and 20.3 ± 7.7 months, respectively. Results: The perioperative characteristics did not differ between the two groups except that the aortic cross-clamp time and the cardiopulmonary bypass time of the TES group were longer than that of the sternotomy group. One patient in the TES group underwent reoperation. During the follow-up period, one death due to an unknown cause, one stroke for each group, and two patients with prosthetic dysfunction. The rates of atrial rhythm categories at the time of post-operation, discharge, 3-month, 6-month, and 1-year follow-up did not differ between the two groups. At 1-year follow-up, the rates of freedom from AF of the sternotomy group and the TES group were 90.9% and 91.9%, respectively; meanwhile, the rates of sinus rhythm were 86.4% and 86.5%, respectively.[1] Conclusions: AF ablation combined with mitral valve surgery can be performed through port-access as safely and effectively as through the traditional approach.