Surgical Ablation Of Atrial Fibrillation And Left Atrial Appendage Occlusion By A Totally Videothoracoscopic Approachnew Paradigm?

Introduction Atrial fibrillation (AF) contributes to increase morbidity and mortality. Pharmacological and percutaneous catheter therapies are unsatisfactory, with potential serious adverse effects. Cox-Maze III/IV surgery, with higher rates of success, has not been widely adopted because of the associated complexity of the procedure. Objectives We describe the surgical technique of AF ablation and concomitant occlusion of the left atrial appendage, with a totally videothoracoscopic and our results, including duration of surgery, number of days of hospital stay, complications and maintenance of sinus rhythm after surgery, at 6, 12 and 18 months of follow-up. Materials and Methods We performed a retrospective analysis of the first patients submitted to surgical ablation of AF and concomitant occlusion of the left atrial appendage, with a totally videothoracoscopic approach in our institution. Results We studied 15 patients (ages ranging from 39 to 75 years old; 54,5% female gender). Mean time since the diagnosis of AF was 5,75 years. All had been submitted to prior catheter ablation (mean of 2 attempts). Mean diameter and volume of the left atrium was 42 mm (M-mode) and 70 ml (43 ml/m2), respectively. Mean duration of surgery was 2 hours and 22 minutes. In one patient we had to convert the surgery to median sternotomy. Mean hospital stay was 4,8 days. Mean time of follow-up was 12 months. During follow-up, 91%, 90% and 80% of the patients were in sinus rhythm, 6, 12 and 18 months, respectively. Conclusions This surgical approach represents a real benefit for those patients with multiple attempts of catheter ablation without success. However, a larger sample of patients with a longer period of follow-up is necessary for further conclusions.