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. 2022 Oct 4;62(5):ezac409.
doi: 10.1093/ejcts/ezac409.

Unilateral left-sided thoracoscopic ablation of atrial fibrillation concomitant to minimally invasive bypass grafting of the left anterior descending artery

Claudia A J van der Heijden  1 , Patrique Segers  1 , Anna Masud  1 , Vanessa Weberndörfer  2 , Sevasti-Marisevi Chaldoupi  2   3 , Justin G L M Luermans  2   3 , Geertruida P Bijvoet  2   3 , Bas L J H Kietselaer  3   4 , Sander M J van Kuijk  5 , Paul J C Barenbrug  1 , Jos G Maessen  1   3 , Elham Bidar  1   3 , Bart Maesen  1   3
Affiliations

Unilateral left-sided thoracoscopic ablation of atrial fibrillation concomitant to minimally invasive bypass grafting of the left anterior descending artery

Claudia A J van der Heijden et al. Eur J Cardiothorac Surg. .

Abstract

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.

Keywords: Atrial fibrillation; Minimally invasive; Minimally invasive direct coronary bypass grafting; Thoracoscopic ablation.

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Figures

Figure 1:
Figure 1:
Flowchart representing patient individualized treatment strategies and outcomes. AF: atrial fibrillation; AFL: atrial flutter; AT: atrial tachycardia; CA: catheter ablation; CAD: coronary artery disease; CRT-D: cardiac resynchronization therapy-defibrillator; CTI: cavo-triscupid isthmus; ECV: electrical cardioversion; iCMP: ischaemic cardiomyopathy; LIMA-LAD: left internal mammary artery–left anterior descending artery; LV: left ventricle; NSTEMI: non-ST elevated myocardial infarction; PCI: percutaneous coronary intervention; PV: pulmonary vein; PVI: PV isolation; RCA: right coronary artery; RSPV: right superior pulmonary vein; SR: sinus rhythm; WACA: wide antral circumferential ablation.
Figure 2:
Figure 2:
Kaplan–Meier survival curve representing the probability of being free from atrial fibrillation recurrences. AF: atrial fibrillation.
Figure 3:
Figure 3:
Left atrial ejection fraction at baseline and after surgery.
None
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