title: Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation.
abstract: OBJECTIVE
  Pulmonary vein isolation is curative in selected patients with atrial fibrillation. The objective of this study was to assess the feasibility and safety (midterm results) of video-assisted thoracoscopic epicardial pulmonary vein isolation.
  
  
  METHODS
  Twenty-seven patients (22 male patients) with atrial fibrillation (18 paroxysmal, 4 persistent, and 5 permanent; average age, 57 years) underwent bilateral video-assisted thoracoscopic off-pump epicardial pulmonary vein isolation and exclusion of the left atrial appendage. All patients had had unsuccessful drug therapy or were intolerant to antiarrhythmic drug therapy or were intolerant to warfarin. The approach included two 10-mm ports and one 5-cm working port (non-rib spreading) bilaterally. Pulmonary vein isolation was achieved bilaterally by using a bipolar radiofrequency device. The left atrial appendage was excised with a surgical stapler.
  
  
  RESULTS
  Bilateral pulmonary vein isolation and left atrial appendage excision was performed successfully in all patients. There were no conversions to sternotomy or thoracotomy. All patients were extubated in the operating room. Postoperative complications in 3 patients were minor and resolved within 48 hours. One morbidly obese patient had more serious complications related to comorbid conditions. Average postoperative follow-up is approximately 6 months (173.6 days). Twenty-three patients have been followed up for greater than 3 months, and 21 of these patients are free of atrial fibrillation (91.3%). The results of magnetic resonance angiography were normal (no pulmonary vein stenosis) in 12 of 12 patients evaluated 3 to 6 months postoperatively.
  
  
  CONCLUSIONS
  Bilateral video-assisted thoracoscopic pulmonary vein isolation with excision of the left atrial appendage is feasible and safe and offers a promising, new, minimally invasive, beating-heart approach for curative surgical treatment of atrial fibrillation.
authors.affiliation: Section of Cardiothoracic Surgery, The University of Cincinnati College of Medicine, Cincinnati, Ohio 45267, USA. wolfr@ucmail.uc.edu
authors.forename: Randall K
authors.initials: RK
authors.lastname: Wolf
authors.forename: E William
authors.initials: EW
authors.lastname: Schneeberger
authors.forename: Robert
authors.initials: R
authors.lastname: Osterday
authors.forename: Doug
authors.initials: D
authors.lastname: Miller
authors.forename: Walter
authors.initials: W
authors.lastname: Merrill
authors.forename: John B
authors.initials: JB
authors.lastname: Flege
authors.forename: A Marc
authors.initials: AM
authors.lastname: Gillinov
mesh_terms: D000328:Adult; D000368:Aged; D020517:Atrial Appendage / Q000601:surgery*; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D017115:Catheter Ablation / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011667:Pulmonary Veins / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods