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Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation.
| Content Provider | Semantic Scholar |
|---|---|
| Author | Wolf, Randall Kevin Schneeberger, E. William Miller, Doug Merrill, Walter Flege, John B. Gillinov, Alan Marc |
| Copyright Year | 2005 |
| Abstract | OBJECTIVE Pulmonary vein isolation is curative in selected patients with atrial fibrillation. The objective of this study was to assess the feasibility and safety (midterm results) of video-assisted thoracoscopic epicardial pulmonary vein isolation. METHODS Twenty-seven patients (22 male patients) with atrial fibrillation (18 paroxysmal, 4 persistent, and 5 permanent; average age, 57 years) underwent bilateral video-assisted thoracoscopic off-pump epicardial pulmonary vein isolation and exclusion of the left atrial appendage. All patients had had unsuccessful drug therapy or were intolerant to antiarrhythmic drug therapy or were intolerant to warfarin. The approach included two 10-mm ports and one 5-cm working port (non-rib spreading) bilaterally. Pulmonary vein isolation was achieved bilaterally by using a bipolar radiofrequency device. The left atrial appendage was excised with a surgical stapler. RESULTS Bilateral pulmonary vein isolation and left atrial appendage excision was performed successfully in all patients. There were no conversions to sternotomy or thoracotomy. All patients were extubated in the operating room. Postoperative complications in 3 patients were minor and resolved within 48 hours. One morbidly obese patient had more serious complications related to comorbid conditions. Average postoperative follow-up is approximately 6 months (173.6 days). Twenty-three patients have been followed up for greater than 3 months, and 21 of these patients are free of atrial fibrillation (91.3%). The results of magnetic resonance angiography were normal (no pulmonary vein stenosis) in 12 of 12 patients evaluated 3 to 6 months postoperatively. CONCLUSIONS Bilateral video-assisted thoracoscopic pulmonary vein isolation with excision of the left atrial appendage is feasible and safe and offers a promising, new, minimally invasive, beating-heart approach for curative surgical treatment of atrial fibrillation. |
| Starting Page | 797 |
| Ending Page | 802 |
| Page Count | 6 |
| File Format | PDF HTM / HTML |
| Alternate Webpage(s) | http://www.afibmaze.com/files/wolfmaze.pdf |
| Alternate Webpage(s) | http://www.mc.vanderbilt.edu/root/sbworddocs/res_edu_thoracic/Wolf_Videoassisted_bilateral_pulmonary_vein_isolation_and_left_2.pdf |
| PubMed reference number | 16153931v1 |
| Volume Number | 130 |
| Issue Number | 3 |
| Journal | The Journal of thoracic and cardiovascular surgery |
| Language | English |
| Access Restriction | Open |
| Subject Keyword | Anti-Arrhythmia Agents Atrial Fibrillation Bone structure of rib Exclusion Heart Atrium Idiopathic Pulmonary Fibrosis Left Atrial Appendage Left-Sided Heart Failure Magnetic Resonance Angiography Obesity Operating Room Patients Pharmacotherapy Postoperative Complications Pulmonary Valve Insufficiency Pulmonary veins Stenosis, Pulmonary Vein Sternotomy (procedure) Structure of auricular appendage Surgical Staplers Thoracotomy Warfarin angiogram radiofrequency |
| Content Type | Text |
| Resource Type | Article |
