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首页> 外文期刊>Journal of Thoracic Disease >Stand-alone surgical ablation for atrial fibrillation: a novel bilateral double-port approach
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Stand-alone surgical ablation for atrial fibrillation: a novel bilateral double-port approach

机译：独立的外科房颤消融术：一种新颖的双边双端口方法

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Background: To explore an effective, reproducible and less invasive surgical approach for lone atrial fibrillation (AF). Methods: A modified “mini-maze” including pulmonary vein isolation (PVI), box-lesion and left atrial appendage (LAA) resection was applied for AF patients in our center from January 2016 to June 2017. A 2.5 cm thoracotomy extended with tissue retractor was made as working port in the fourth intercostal space on each anterior side of the chest. The thoracoscope was inserted in another port lateral to main port for observing. During PVI, the tip of the clamp could be adjusted to reach as superior as the roof of left atrium for transmural lesions. The floor line was made by linear ablation pen. The LAA was removed by stapler before PVI for better exposure of the roof. Results: This modified “mini-maze” was successfully completed in 53 non-paroxysmal AF patients except 1 was converted to sternotomy due to intraoperative hemorrhage. All patients recovered uneventfully. Seven-day Holter was accessed in 3, 6 and 12 months respectively in all patients. The mean follow-up was 14 (range, 3–30) months. Sinus rhythm was achieved in 48.1%, 64.8% before discharge and 3 months after surgery respectively, Twenty-eight patients in sinus rhythm or not, underwent catheter mapping and ablation three months after the operation to conform the lesion set made by this procedure. Sinus rhythm reached 87.0% after subsequent catheter ablation without any anti-arrhythmia treatment at 12 months. All patients survived without stroke, hemorrhage and pulmonary vein stenosis. Conclusions: Modified “mini-maze” procedure is safe, less invasive and highly reproducible for lone AF. Sequential hybrid procedure will shape the treatment of non-paroxysmal AF.
机译：背景：探讨有效的，可重复的和侵入性小的外科手术方法，用于孤立性房颤（AF）。方法：自2016年1月至2017年6月，对我中心的AF患者进行改良的“迷宫式”手术，包括肺静脉隔离术（PVI），盒子病变术和左心耳切除术（LAA）切除术。2.5 cm的开胸手术扩大组织牵开器被制作为胸部前侧第四肋间隙中的工作端口。将胸腔镜插入主端口旁的另一个端口进行观察。在进行PVI期间，可以调整夹具的尖端，使其达到与左心房顶一样的透壁病变。地板线由线性消融笔制成。在PVI之前，用订书机将LAA移开，以更好地暴露屋顶。结果：53例非阵发性房颤患者成功完成了这种改良的“迷宫式”手术，只有1例因术中出血转为胸骨切开术。所有患者康复良好。所有患者分别在3、6和12个月内接受7天动态心电图检查。平均随访时间为14（3至30）个月。窦性心律分别在出院前和手术后3个月达到48.1％，64.8％，有或没有窦性心律的28例患者在术后三个月进行了导管标测和消融，以符合该程序设定的病变。继而在12个月未进行任何抗心律不齐治疗的导管消融后，窦律达到87.0％。所有患者均存活，无中风，出血和肺静脉狭窄。结论：改良的“迷宫式”手术对于孤独性房颤是安全，侵入性小且高度可重复的。顺序混合程序将影响非阵发性房颤的治疗。

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