Right minithoracotomy versus conventional median sternotomy for patients undergoing mitral valve surgery and Cox-maze IV ablation with entirely bipolar radiofrequency clamp

• Published in: Heart and vessels Vol. 33; no. 8; pp. 901 - 907
• Main Authors: Jiang, Zhaolei, Tang, Min, Ma, Nan, Liu, Hao, Ding, Fangbao, Bao, Chunrong, Mei, Ju
• Format: Journal Article
• Language: English
• Published: Tokyo Springer Japan 01-08-2018; Springer Nature B.V
• Subjects: Ablation; Adult; Aged; Aorta; Atrial Fibrillation - surgery; Atrium; Biomedical Engineering and Bioengineering; Cardiac Surgery; Cardiac Surgical Procedures - methods; Cardiology; Catheter Ablation - instrumentation; Catheters; Equipment Design; Etiology; Female; Fibrillation; Follow-Up Studies; Heart surgery; Heart Valve Diseases - complications; Heart Valve Diseases - surgery; Heart valves; Humans; Male; Mechanical ventilation; Medicine; Medicine & Public Health; Middle Aged; Minimally Invasive Surgical Procedures - methods; Mitral valve; Mitral Valve - surgery; Original Article; Patients; Radio frequency; Retrospective Studies; Rheumatic heart disease; Sinus; Sternotomy - methods; Surgery; Thoracotomy - methods; Treatment Outcome; Vascular Surgery; Ventilation; Radiofrequency ablation; Mitral valve; Minimally invasive surgery; Atrial fibrillation
• ISSN: 0910-8327; 1615-2573
• DOI: 10.1007/s00380-018-1126-4

Cox-maze IV ablation by bipolar radiofrequency clamp was considered to be only performed through median sternotomy (MS), but impossible through right minithoracotomy (RM). Now, we developed a novel technique of performing Cox-maze IV ablation entirely by bipolar clamp through RM. To compare the outcomes of RM or MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. All 152 patients underwent mitral valve surgery and concomitant Cox-maze IV ablation with bipolar clamp through RM (
n
 = 69) or MS (
n
 = 83) were analyzed for outcome differences. The etiology of mitral valve disease was rheumatic (
n
 = 97) and degenerative (
n
 = 55). All patients had long-standing persistent atrial fibrillation (AF). Diameter of left atrium ranged from 42 to 60 mm. All patients successfully underwent Cox-maze IV ablation by bipolar clamp. RM group had longer cardiopulmonary bypass time (130.3 ± 17.7 vs 115.3 ± 14.4 min;
P
 < 0.001) and aortic cross-clamp time (91.8 ± 12.7 vs 74.6 ± 9.3 min;
P
 < 0.001). But mechanical ventilation time (14.2 ± 6.6 vs 21.3 ± 9.0 h;
P
 < 0.001) and hospital length of stay (9.3 ± 2.6 vs 11.7 ± 3.0 days;
P
 < 0.001) were shorter in RM group. At discharge, the maintenance of normal sinus rhythm (NSR) was 94.2% in RM group and 95.1% in MS group (
P
 = 1.000). Cumulative maintenance of NSR at 2 years postoperatively was 85.1 ± 5.8% in RM group and 88.6 ± 3.6% in MS group (
P
 = 0.767). RM can achieve similar therapeutic effect to MS for patients undergoing mitral valve surgery and concomitant Cox-maze IV ablation with entirely bipolar clamp. In addition, patients through RM had faster recovery.