Septal-superior exposure in mitral valve surgery with radiofrequency ablation.
BACKGROUND
We review the results of surgical radiofrequency ablation of both atria in patients of mitral valve disease approached by septal-superior exposure and discuss the availability of this approach.


METHODS
Eighteen patients with a mean age of 65 years were included in this study. Thirteen patients had mitral valve regurgitation predominantly and five had mitral valve stenosis. Eleven patients underwent mitral valve plasty and valve replacement was carried out in seven. All ablation lesions were created on both atria using radiofrequency energy delivered by a unipolar malleable radiofrequency ablation catheter with seven electrodes at a minimum temperature of 80-85 degrees C for a period of 2 min.


RESULTS
At the time of discharge, 14 patients were showed normal sinus rhythm and one patient remained in AF. The other three patients were free from atrial fibrillation; however, they received dual-mode, dual-pacing, dual-sensing pacemaker implantation because of bradycardia during the early postoperative phase. At a mean time of 7 months after surgery, all patients were free from atrial fibrillation; 13 patients showed normal sinus rhythm and five patients received dual-mode, dual-pacing, dual-sensing pacemakers.


CONCLUSIONS
Septal-superior exposure provides an excellent operative view both for mitral valve surgery and for radiofrequency ablation. However, this exposure has not been considered a first-line approach because of the high rate of pacemaker implantation.
Ishikawa
Susumu
S
Department of Cardiovascular Surgery, Teikyo University School on Medicine, Tokyo, Japan. ishikawa@med.teikyo-u.ac.jp
Obayashi
Tamiyuki
T
Kawasaki
Akio
A
Suzuki
Yoshitaka
Y
Neya
Kazuo
K
Ohki
Satoshi
S
Kugawa
Satoshi
S
Hayama
Tamuro
T
Ueda
Keisuke
K
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures; D017115:Catheter Ablation; D005260:Female; D006325:Heart Atria / Q000601:surgery; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D008946:Mitral Valve Stenosis / Q000601:surgery