Minimally invasive cardiothoracic surgery for atrial fibrillation: a combined Japan-US experience.
BACKGROUND
The cut-and-sew Maze procedure has historically been the most efficacious therapy for patients with atrial fibrillation (AF) that is refractory to medical management, but is not widely used as a stand-alone treatment for AF. New ablation technologies can create pulmonary vein (PV) isolation without cardiopulmonary bypass.


RESULTS
The 'thoracoscopic mini-Maze' procedure includes bilateral PV isolation, ablation of the epicardial ganglionated plexi and excision of the left atrial appendage using small bilateral thoracotomies with thoracoscopic assistance. Between January 2006 and April 2007, 20 thoracoscopic mini-Maze procedures were performed at 2 institutions and over a mean follow-up of 16.6 months, 18 (90%) patients are in sinus rhythm. Perioperative bleeding complications occurred in 3 patients (15%) and there was 1e (5%) late instance of atrial flutter that required a right-sided ablation. None of the patients died or needed a pacemaker.


CONCLUSIONS
Early experience with the thoracoscopic mini-Maze procedure suggests that sinus rhythm can be re-established in most patients in the short-term and with more experience the rate of complications should reduce, which is required prior to defining the role of this therapy in the future treatment of AF.
Matsutani
Noriyuki
N
Department of Surgery II, National Defense Medical College, Tokorozawa, Japan. grd1710@ndmc.ac.jp
Takase
Bonpei
B
Ozeki
Yuichi
Y
Maehara
Tadaaki
T
Lee
Richard
R
D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D017115:Catheter Ablation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D007564:Japan; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011667:Pulmonary Veins / Q000601:surgery; D016896:Treatment Outcome; D014481:United States