title: Minimally invasive fibrillating heart surgery: a safe and effective approach for mitral valve and surgical ablation for atrial fibrillation.
abstract: BACKGROUND
  Minimally invasive (MI) approaches to mitral valve surgery (MVS) and surgical ablation for atrial fibrillation (AF) are now performed routinely, and avoidance of aortic manipulation and cardioplegic arrest may further simplify the procedure. We present our experience with MI fibrillatory cardiac operations without aortic cross-clamping for MVS and AF ablation.
  
  
  METHODS
  Between January 2007 and August 2012, 292 consecutive patients underwent MVS (n = 177), surgical ablation (n = 81), or both (n= 34), with fibrillating heart through a right minithoracotomy. Baseline characteristics, perioperative outcomes, and long-term survival were evaluated.
  
  
  RESULTS
  The mean age was 56.8 years (range, 20-83 years). Reoperations were performed in 25 patients (9%). The overall MV repair rate was 93.4% (198/211), including 13.1% (26/198) with anterior leaflet repair. Repair was performed in 100% of patients with myxomatous MV disease. Of isolated posterior mitral valve repairs, 60.5% underwent repair with neochords (W.L. Gore and Associates, Flagstaff, AZ), and 29.7% underwent triangular resection. There was 1 operative mortality (0.3%), no intraoperative conversions to sternotomy, 4 reoperations (1.4%), 1 stroke (0.3%), and 1 transient ischemic attack (0.3%). The 12-month return to sinus rhythm was 93%, and sinus rhythm without class I and class III antiarrhythmic medication was 85%. One- and 2-year cumulative survival was 98.5% and 97.8%, respectively. At mean follow-up of 27.3 months, our outcomes compared favorably with the 2011 Society of Thoracic Surgeons (STS) nationally reported outcomes.
  
  
  CONCLUSIONS
  We demonstrated that low operative mortality and low stroke rate with MI fibrillating cardiac operations without cross-clamping allows for MVS and AF ablation. Our results suggest that the MI fibrillating heart approach is safe and effective.
authors.affiliation: Inova Heart and Vascular Institute, Falls Church, Virginia, USA. pmassimiano@cvtsa.com
authors.forename: Paul S
authors.initials: PS
authors.lastname: Massimiano
authors.forename: Bobby
authors.initials: B
authors.lastname: Yanagawa
authors.forename: Linda
authors.initials: L
authors.lastname: Henry
authors.forename: Sari D
authors.initials: SD
authors.lastname: Holmes
authors.forename: Graciela
authors.initials: G
authors.lastname: Pritchard
authors.forename: Niv
authors.initials: N
authors.lastname: Ad
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000379:methods; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D008943:Mitral Valve / Q000601:surgery*; D055815:Young Adult
keywords: 24; AF; COPD; CPB; HRQL; ICU; LVEF; MI; MVS; NYHA; New York Heart Association; SF-12; SR; STS; Short-Form 12; Society of Thoracic Surgeons; TEE; atrial fibrillation; cardiopulmonary bypass; chronic obstructive pulmonary disease; health-related quality of life; intensive care unit; left ventricular ejection fraction; minimally invasive; mitral valve surgery; sinus rhythm; transesophageal echocardiography