Unilateral left-sided thoracoscopic atrial fibrillation ablation concomitant to minimally invasive direct coronary artery bypass grafting was feasible and safe, with 81% of patients in sinus rhythm at 12 months.
Cohort (n=23)
No
Is unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB surgery feasible, safe, and efficacious in patients with AF and critical LAD stenosis?
Unilateral left-sided thoracoscopic AF ablation combined with MIDCAB is a feasible and safe approach that effectively restores sinus rhythm and improves left atrial ejection fraction in patients with AF and LAD stenosis.
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.
Heijden et al. (Wed,) conducted a cohort in Atrial fibrillation and critical left anterior descending artery stenosis (n=23). Unilateral left-sided thoracoscopic AF ablation and concomitant off-pump MIDCAB surgery was evaluated on Procedural feasibility and safety up to 12 months of follow-up. Unilateral left-sided thoracoscopic atrial fibrillation ablation concomitant to minimally invasive direct coronary artery bypass grafting was feasible and safe, with 81% of patients in sinus rhythm at 12 months.