THORACOSCOPIC BIATRIAL MAZE PROCEDURE – A NOVEL MINIMAL-INVASIVE REMEDY WITH PROMISING MIDTERM RESULTS


Ali Khoynezhad, M.D., Ph.D., Cedars-Sinai Medical Center, Los Angeles, CA, USA

Minimal Access atrial fibrillation has undergone significant progression in last few years. The lesion set has progressed from simple pulmonary vein (PV) isolation to a more comprehensive lesion set, which can be placed epicardially, and more closely replicates the left atrial lesions of the Cox maze III. Less-invasive access has progressed from bilateral mini thoracotomies initially described by Wolf and coworkers, to a totally thorascopic approach initially described by Puskas and coworkers. Besides antral lesions, complete box lesion is produced connecting all pulmonary veins. Furthermore, left atrial isthmus lesion set is created by connecting the both superior pulmonary veins to the non/left coronary commissure of the aortic valve. This triangle is on the dome of the left atrium and connected to the fibrous skeleton of the heart. Next the pericardial ganglionic plexi are tested and ablated, and entrance and exit block is confirmed using intraoperative electrophysiological interrogation. Lastly, the left atrial appendage is excluded under Transesophageal echocardiogram using a dedicated left atrial In 2012, fourteen patients with previous unsuccessful electrophysiological ablation for persistent or longstanding persistent atrial fibrillation underwent thoracoscopic Maze using aforementioned protocol. The average hospital stay was three days, and there was no stroke, myocardial infarction or mortality. 14-day-holter monitors were collected at 3, 6 and 12 month, confirming all patients being in normal sinus rhythm. One patient required electrophysiological ablation of persistent atrial flutter, with subsequent cure of the atrial flutter. No patient has had recurrence of atrial fibrillation in the follow-up.