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The Journal of Cardiovascular Surgery 2005 February;46(1):69-75


language: English

Intraoperative treatment of chronic atrial fibrillation with ultrasound

Guffi M. 1, Visconti Brick A. 2, Seixas T. 3, Portilho C. 2, Klier Peres A. 2, Vieira J. J. Jr. 2, de Melo Neto R. 2, de Melo Araújo J. 2

1 Department of Cardiovascular Surgery Hôpital de la Tour, Geneva, Switzerland 2 Department of Cardiovascular Surgery Hospital das Forças Armadas, Brasília, Brazil 3 Department of Electrophysiology Cardioclínica, Brasília, Brazil.


Aim. The pur­pose of ­this ret­ro­spec­tive ­study is to eval­u­ate the effi­ca­cy of intra­op­er­a­tive atri­al com­part­men­tal­iza­tion uti­liz­ing ultra­sound (US) ener­gy in select­ed ­patients ­with chron­ic atri­al fib­ril­la­tion (CAF).
Methods. From March 1999 to June 2000, 27 ­patients ­with ­ages rang­ing ­from 15 to 69 (­mean 44.62±15.61 ­years), 15 of ­whom ­were ­female, under­went intra­op­er­a­tive atri­al com­part­men­tal­iza­tion ­with US. Mitral ­valve replace­ment was per­formed in 22 ­patients, ­mitral ­valve ­repair in 4 and 1 ­patient ­with par­ox­ys­mal atri­al fib­ril­la­tion (AF) under­went iso­lat­ed atri­al com­part­men­tal­iza­tion. The com­part­men­tal­iza­tion pro­ce­dure was start­ed ­using an ultra­son­ic ­device (UltraCision®) at the lev­el of the ­right atri­um on car­di­o­pul­mo­nary ­bypass (CPB) and ­with beat­ing ­heart, and ­then, ­after the ­mitral ­valve pro­ce­dure, the abla­tion-­lines ­were ­traced in an invert­ed U-­shape, involv­ing the 4 pul­mo­nary ­veins. All ­patients ­were giv­en verap­a­mil or ami­od­a­rone for electri­cal atri­al remod­el­ing for 6 ­months.
Results. Time of sur­gery was 166 min on aver­age, ­that is approx­i­mate­ly 79 min of CPB, 59 min of aor­tic cross­clamp­ing, 12.5 min for ­right atri­al ­lesion ­lines and 14 min for the ­left ­ones. After wean­ing CPB, all the ­patients main­tained ade­quate car­diac out­put. Immediate rever­sion to ­sinus ­rhythm was ­achieved in 24 ­patients (88.8%). A ­small intra­op­er­a­tive ­left atri­al ­wall rup­ture due to the abla­tion tech­nique was eas­i­ly ­repaired by a ­direct con­tin­u­ous ­suture. Another com­pli­ca­tion ­observed in 1 ­patient was a ster­nal instabil­ity, ­which was ­fixed suc­cess­ful­ly. Two ­patients ­died ­because of post­op­er­a­tive res­pir­a­to­ry fail­ure due to bilat­er­al pneu­mo­nia in 1 ­case and low car­diac out­put, com­pli­cat­ed by sep­ti­ce­mia. The phar­mac­o­log­i­cal ­anti-arrhyth­mic treat­ment was ­stopped 6 ­months ­after sur­gery. During 29 ­months of fol­low-up, 20 ­patients (74%) ­were ­still in ­sinus ­rhythm.
Conclusion. The use of US dur­ing ­mitral ­valve oper­a­tion in ­patients ­with CAF ­allowed for ­easy and rap­id rees­tab­lish­ment of the ­sinus ­rhythm. This tech­nique mod­i­fies and ­makes the Maze pro­ce­dure easi­er, decreas­es sur­gi­cal ­time and the inci­dence of post­op­er­a­tive com­pli­ca­tions.

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