Primary experience of treating 23 lone atrial fibrillation patients with a completely thoracoscopic modified Maze procedure / 中华心血管病杂志

<p><b>OBJECTIVE</b>To evaluate the safety and feasibility of a completely thoracoscopic modified Maze procedure for treatment of patients with lone atrial fibrillation(AF).</p><p><b>METHODS</b>From September 2010 to October 2011, completely thoracoscopic modified Maze procedure was performed in 23 patients with lone atrial fibrillation (14 paroxysmal AF and 9 persistent AF). All patients were either refractory or intolerant to antiarrhythmic drug therapy or already experienced unsuccessful catheter-based ablation. This procedure includes three 1 cm ports for thoracoscopic camera and ablation device on each side of chest wall. Bilaterally pulmonary vine isolation was made by an Atricure TM bipolar radiofrequency device. Two epicardial ablation lines were created on LAPW to connect bilaterally pulmonary vine ablation lesion using Coolrail linear pen. LAA was removed by a Johnson and Johnson EZ45G stapler.</p><p><b>RESULTS</b>The procedures were successful in all the patients, 20 patients were in sinus rhythm immediately after surgery, 2 patients were still in AF rhythm and 1 patient in pacing rhythm post surgery. Three-month follow up were finished in 23 patients and there was 1 patient in AF rhythm, 95.7% patients were free of AF; 6-month follow up were finished in 22 patients, 3 patients were in AF rhythm and 2 patients in AFL rhythm, 77.3% patients were free of AF.</p><p><b>CONCLUSION</b>Our results suggested that the completely thoracoscopic modified Maze procedure is a safe, feasible and effective technique for treating patients with atrial fibrillation.</p>

Efficacy comparison between video-assisted minimally invasive radiofrequency ablation and catheter ablation in the treatment of persistent atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>To compare the efficacy of the video-assisted minimally invasive radiofrequency ablation in comparison with catheter ablation for the treatment of persistent atrial fibrillation (AF).</p><p><b>METHODS</b>A total of 172 patients [116 male, mean age (56 ± 12) years] with persistent AF underwent ablation procedures during the last 4 years in our institute (83 patients underwent video-assisted minimally invasive radiofrequency ablation, group MIA and 89 patients underwent circumferential pulmonary vein linear ablation, group CA). Mean duration of preoperative AF was (72 ± 68) months. Patients were follow-uped for a period of 1 to 3.6 years [mean (2.2 ± 0.8) years].</p><p><b>RESULTS</b>There was no procedure related death. During follow-up, one patient died of encephalorrhagia in CA group, one patient died of sudden death in each group. At the end of the procedure, there were 67 sinus rhythm (39.0%), 4 pacing rhythm (2.3%), 29 atrial flutter or atrial tachycardia (16.9%) and 72 AF (41.9%). Before discharge, sinus rhythm was recorded in 53 patients (63.9%) of MIA group and in 78 patients (87.6%) of CA group; AF recorded in 24 patients (28.9%) of MIA group and in 4 patients (4.5%) of CA group (P < 0.01). At the latest follow-up, sinus rhythm was recorded in 65 patients (79.3%) of MIA group and in 54 patients (62.1%) of CA group; AF or atrial flutter was recorded in 14 patients (17.1%) of MIA group and in 24 patients (27.6%) of CA group (P = 0.028). The Kaplan-Meier survival analysis showed that the long-term efficacy of MIA is superior to CA in terms of incidence of free of AF, AF recurrence and antiarrhythmic drugs (P = 0.03, P = 0.028, P = 0.017, respectively).</p><p><b>CONCLUSIONS</b>The video-assisted minimally invasive ablation was safe and effective, and had an optimistic long-term success rate for patients with long-lasting persistent AF. Thus, a randomized study comparing the long-term efficacy between the two procedures for patients with long-lasting persistent AF is warranted.</p>

Video-assisted minimally invasive radiofrequency ablation in the treatment of persistent atrial fibrillation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of the video-assisted minimally invasive radiofrequency ablation combined irbesartan use for the treatment of the persistent atrial fibrillation (AF).</p><p><b>METHODS</b>From January 2006 to December 2009, 83 patients with persistent AF having a video-assisted minimally invasive radiofrequency ablation. There were 58 males, 25 females with a mean age of (57 ± 11) years. Mean duration of preoperative AF was (61 ± 65) months. Follow-up for the whole patients ranged from 1.0 to 3.6 years [mean (2.2 ± 0.8) years]. Patients were randomly divided into irbesartan group (n = 42) and without irbesartan group (n = 41) postoperatively.</p><p><b>RESULTS</b>No patient died postoperatively. During follow-up, there was 1 patient died of unknown reason. At the end of the procedure, 38 patients (45.7%) were sinus rhythm, 4 patients (4.9%) were pacing rhythm, 5 patients (6.0%) were atrial flutter or atrial tachycardia, and 36 patients (43.4%) were AF. Before discharge, 53 patients (63.9%) were sinus rhythm, 24 patients (28.9%) were AF. At late follow-up, 65 patients (80.2%) were sinus rhythm; 14 patients (17.3%) were AF or atrial flutter. After follow-up, the Kaplan-Meier analysis showed the irbesartan group had fewer patients with AF (P = 0.020). The hazard ratio for AF recurrence in patients treated with irbesartan was 0.24 (95% CI: 0.087 to 0.637, P = 0.004).</p><p><b>CONCLUSIONS</b>The video-assisted minimally invasive radiofrequency ablation is safe and effective. The patients treated with irbesartan have a lower rate of recurrence of AF.</p>

Intraoperative treatment for atrial fibrillation using bi-polar radiofrequency ablation system: a clinical report of 91 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To observe the short and mid-term therapeutic effects of Bi-polar ablation systems for intraoperative treatment of atrial fibrillation (AF).</p><p><b>METHODS</b>From March 2005 to January 2007, 91 patients received intraoperative treatment of atrial fibrillation with Bi-polar ablation systems, including 5 cases of paroxysmal atrial fibrillation and 86 persistent/permanent cases. The main concomitant heart diseases were rheumatic mitral valve diseases. Atricure Dry Ablation System was used for 37 cases and Cardioblate Irrigated Ablation System for 54 cases. The ablation lesion patterns included Cox-maze III, Modified Cox Mini-maze and Left-sided Maze.</p><p><b>RESULTS</b>Mean ablation time was (14.1+/-6.7) min. No ablation-related complications occurred. Three patients died perioperatively. Two patients had permanent pacemaker implantation 3 months after operation. One case suffered from stroke and lower limb thrombosis 2.5 years after operation. Follow-up lasted for 6 to 29 months. The none-AF rhythm were 62.5%, 85.2%, 79.0% and 74.5% at discharge, 3 months, 6 months, and>or=12 months respectively. Compared to Uni-polar Ablation therapy group, the restoration of sinus rhythm in Bi-polar group were significantly higher at 6 months and>or=12 months postoperatively. The latest follow-up results indicated that 100% of preoperative paroxysmal atrial fibrillation patients restored sinus rhythm and 75.3% of persistent/permanent patients were free from atrial fibrillation. The none-AF rhythm of Atricure group (81.1%) showed no difference from the Cardioblate (77.5%). Meanwhile there were no significant differences among the three ablation lesion groups.</p><p><b>CONCLUSION</b>Intraoperative radiofrequency ablation with Bi-polar systems is a feasible, safe and highly effective surgical option compared to the Uni-polar ablation technique.</p>

Video-assisted minimally invasive cardiac surgery for atrial fibrillation: a report of 57 cases / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the feasibility and the efficacy of a new video-assisted minimally invasive surgery for patients with atrial fibrillation (AF).</p><p><b>METHODS</b>From December 2006 to October 2007, 57 patients who were 56.4 years old in average underwent the video-assisted minimally invasive cardiac operation for AF, and there were 40 male patients. Thirty-eight patients were paroxysmal AF, 7 patients were persistent and 12 patients were long-standing persistent. Three patients had failed catheter ablation, and two patients had preoperative permanent pacemaker implantation. All patients went under the minimally invasive procedure. Intraoperative electrophysiological mapping were performed.</p><p><b>RESULTS</b>Mean operation time was 3.5 h. One patient was confirmed of left auricle thrombus, and one received concurrent epicardial cardiac resynchronization therapy during the procedure. There were no perioperative deaths. Acute respiratory failure occurred in 1 patient and acute heart failure in 1 patient after operation. Sixteen patients had electrical cardioversion after operation and during follow-up. At discharge, 78.9% (45/57) of all patients were in sinus rhythm (84.2% for paroxysmal AF, 71.4% for persistent AF, 66.7% for long-standing persistent AF). The patients were followed-up by 1 to 10 months. At 1 month after operation, overall 64.3% (36/56) were in sinus rhythm (67.6% for paroxysmal AF, 57.1% for persistent AF, 58.3% for long-standing persistent AF). At 3 months, overall 83.9% (47/56) were in sinus rhythm (86.5% for paroxysmal AF, 85.7% for persistent AF, 75.0% for long-standing persistent AF). At > or = 6 months, overall 87.0% (20/23) were in sinus rhythm (89.5% for paroxysmal AF, 75.0% for persistent AF). No thromboembolic event was observed during follow-up period.</p><p><b>CONCLUSION</b>The video-assisted minimally invasive cardiac surgery proves to be safe, less traumatic, and presents optimistic early outcomes for paroxysmal AF patients.</p>

Thoracoscopy video assisted minimally invasive bilateral pulmonary vein isolation for treatment of atrial fibrillation / 中华心血管病杂志

<p><b>OBJECTIVE</b>This study is to evaluate the feasibility and safety of thoracoscopy video assisted minimally invasive bilateral pulmonary vein isolation for treatment of atrial fibrillation.</p><p><b>METHODS</b>From December 2006 to April 2007, thorascopy video assisted off-pump epicardial pulmonary vein isolation was performed in 20 patients with atrial fibrillation. All patients were either refractory or intolerant to antiarrhythmic drug therapy or already experienced unsuccessful catheter-based ablation. The procedure includes 21 cm ports for the thoracoscopic camera and ablation device, and a 5 cm working port on each side of the chest wall. Bilaterally pulmonary vine were isolated by using an stricure(TM) bipolar radiofrequency device. LAA was removed by using a Johnson & Johnson EZ45G stapler. Intraoperative pacing and sensing was used to confirm bidirectional block of the ablation lines.</p><p><b>RESULTS</b>The procedure was successful in all patients. Nineteen patients were in sinus rhythm immediately after the surgery and 1 patient was still in AF rhythm post surgery and converted to sinus rhythm by electrical conversion in the operation room. One patient was reintubated because of low SaO2 and 1 patient received IABP for LV failure. Mean operation time was (130 +/- 25) min and average hospital stay was (8.0 +/- 3.8) d. 3-months follow up was finished in 12 patients at after the surgery and 10 patients were free of AF (10/12, 83.3%), 6-months follow up was finished in 3 patients and all in sinus rhythm (3/3, 100%).</p><p><b>CONCLUSION</b>Our results suggested that thoracoscopy video assisted minimally invasive bilateral pulmonary vein isolation is a safe, feasible and effective technique for treatment of atrial fibrillation.</p>

Combined endocardial and epicardial radiofrequency modified Maze procedure in the treatment of atrial fibrillation / 中华外科杂志

<p><b>OBJECTIVE</b>To evaluate the effectiveness of the combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure for the treatment of atrial fibrillation (AF).</p><p><b>METHODS</b>During a period of 3 years, 295 patients with AF having concomitant cardiac surgery underwent the procedure. Patients underwent either the endocardial and epicardial group (n=185) or the endocardial group (n=110) radiofrequency ablation. There were 124 males, 171 females with a mean age of (52 +/- 11) year old. Mean duration of preoperative AF was 36 +/- 43 months. And about 90.8 percent valve pathology was rheumatic. Valve operation was performed in 289 patients, coronary artery bypass graft surgery in 19 patients and congenital heart disease operation in 6 patients respectively. Follow-up for the whole patients ranged from 3 to 47 months (mean 28 +/- 5 months).</p><p><b>RESULTS</b>Ten patients died postoperatively (3.4%). Four patients died of low cardiac output, five patients died of multisystem and organ failure, one patient died of cerebral hernia. There were 2 patients died of nerves system complication during follow-up. At the end of the procedure 228 patients (77.3%) were sinus rhythm, including 78 patients (70.9%) in endocardial group while 150 patients (81.1%) in endocardial and epicardial group (P<0.05). At late follow-up, 191 of 259 patients (73.7%) were in stable sinus rhythm. Sinus rhythm was present in 64 patients (66.0%) in endocardial group while 127 patients (78.4%) in endocardial and epicardial group (P<0.05). Histopathology of the endocardial group revealed foci coagulative necrosis was limited to the endocardial side. While endocardial and epicardial ablation had full-thickness alteration of atrial tissue besides ill defined borders and inflammatory cell infiltration.</p><p><b>CONCLUSIONS</b>Combined endocardial and epicardial saline-irrigated radiofrequency modified maze procedure was performed safely and efficiently. And it restored sinus rhythm better than endocardial ablation only.</p>

Outcome of surgical treatment of post-traumatic tricuspid insufficiency / 中华创伤杂志(英文版)

<p><b>OBJECTIVE</b>To investigate the optimal time and procedure of surgical treatment of traumatic tricuspid insufficiency.</p><p><b>METHODS</b>From May 1984 to September 2004, eight patients underwent operation for traumatic tricuspid valve insufficiency. All patients, male, aged from 7 to 67 years median: 38 years, mean: (38.5 +/- 18.1) years. The intervals between trauma and operation ranged from 1 month to 20 years median: 19 months, mean: (52.5 +/- 80.3) months). In seven patients, tricuspid insufficiency was attributed to blunt chest trauma including vehicle accident in three patients and the other patient is a stab wound. Diagnosis was confirmed by echocardiography. Pre-operative cardiac functions in patients were classified as New York Heart Association (NYHA) classes II-IV. During operation, the anterior leaflet of the tricuspid valve was completely or partially flailed as a result of chordal rupture in all patients. Chordal rupture of septal leaflet was found in one patient. Anterior leaflet was perforated in two patients. Septal leaflet was retracted and adherent to ventricular septum in two patients. Valve repair was intended for all patients. Finally, valve repair was performed successfully in 3 patients and tricuspid replacement was performed in 5 patients.</p><p><b>RESULTS</b>No early or late death occurred. With a follow-up through clinical manifestation and echocardiography for 7-129 months median: 39 months, mean: (53.4 +/- 42.8) months, all patients were classified as NYHA class I, without any changes.</p><p><b>CONCLUSIONS</b>The satisfactory treatment of traumatic tricuspid insufficiency can be obtained by surgical treatment. Earlier surgery may increase the feasibility of tricuspid valve repair and prevent the deterioration of right ventricular function.</p>