ABSTRACT: Despite continued technical improvements, results of transcatheter radiofrequency ablation of atrial fibrillation may be suboptimal in some patient subgroups. Short-term follow-up of minimally invasive epicardial ablation of isolated atrial fibrillation has been encouraging.
One hundred four patients with drug-refractory isolated atrial fibrillation underwent minimally invasive surgical ablation through right 3- to 4-cm minithoracotomy by isolation of pulmonary veins and were followed-up for an average of 17 months. Previous failed transcatheter ablation was not a criterion for this procedure. Antiarrhythmic drugs were continued until postoperative month 6, despite demonstration of stable sinus rhythm.
The procedure was confirmed to be safe (1 case of procedure-related morbidity, no operative deaths) and effective (89% overall freedom from recurrent arrhythmia at follow-up, 96% freedom from paroxysmal atrial fibrillation, 80% freedom from persisting type atrial fibrillation). Results tended to improve with the expansion of the surgical experience. Cox hazard regression and Kaplan-Meier analysis identified persisting type atrial fibrillation and enlarged left atrium as the major predictors of recurrent atrial fibrillation at follow-up. Health-related quality of life was confirmed to be improved at the end of the follow-up relative to baseline in most Medical Outcomes Study 36-Item Short-Form Health Survey domains.
Minimally invasive epicardial ablation of isolated atrial fibrillation yields stable, gradually improving results. Earlier surgical referral is justifiable after careful cardiologic work-up. To define the relative roles of minimally invasive ablation and transcatheter ablation, which may be considered in the future as alternative therapies, a randomized trial to compare these procedures is advisable.
The Journal of thoracic and cardiovascular surgery 05/2011; 142(2):e41-6. · 3.41 Impact Factor
ABSTRACT: We conducted a prospective study of the clinical outcomes and health-related quality of life after implantation of the CorCap support device (Acorn Cardiovascular Inc, St Paul, MN) for dilated cardiomyopathy.
The criteria adopted for CorCap implantation were dilated cardiomyopathy (left ventricular [LV] end-diastolic diameter≥60 mm, LV ejection fraction≤0.30 and >0.10), and New York Heart Association functional class II or III despite maximal medical therapy. Echocardiographic follow-up and evaluation with the Short Form-36 questionnaire were performed.
Included were 39 patients: 5 in New York Heart Association class II and 32 in class III. At 13.3±2.5 months of follow-up, a statistically significant improvement was evident in mean LV volume (LV end-systolic volume from 202±94 to 138±72 ml. p=0.005) and systolic function (LV ejection fraction from 0.26±0.05 to 0.36±0.05, p<0.001). The mean LV sphericity index was significantly increased at the end of the follow-up (p=0.009). Ischemic etiology, diabetes, advanced age, and LV ejection fraction of less than 0.15 predicted lesser reversal of the LV alterations. Operative mortality was 5.1%. Cumulative follow-up mortality was 10.2%. The average Physical Health domain scores (Physical Functioning, Role Physical, General Health) were improved. Average Mental Health domain scores were also increased.
The cardiac support device obtains reverse remodelling of the LV and is useful to improve the quality of life of patients with dilated cardiomyopathy and New York Heart Association class III symptoms of heart failure. The integration of different and complementary strategies (cardiac support device and resynchronization therapy) may represent the key to success for more complex patients, although further studies are required.
The Annals of thoracic surgery 05/2011; 91(5):1356-62. · 3.74 Impact Factor
ABSTRACT: Miniaturized cardiopulmonary bypass (CPB) systems, though more biocompatible, are limited by not being adaptable to all cardiac surgical operations. We evaluate a versatile CPB system [extracorporeal vacuum-assisted device optimized (EVADO)] based on the elimination of roller pumps, separation of extracavitary suctioned blood and state-of-the-art technology for oxygenator systems and digital control. We randomized 165 patients to either EVADO or conventional CPB (cCPB). Surgery could be completed in all cases without conversion to cCPB. The use of EVADO significantly reduced the intraoperative haemolysis (lesser increase in free hemoglobin, P<0.001 vs. control, and lesser decrease in haptoglobin levels, P=0.001 vs. control). Among patients who were submitted to EVADO, postoperative bleeding (P=0.004), transfusions (P=0.046), rate of revision for bleeding (P=0.03), rate of postoperative atrial fibrillation (P=0.007), time to extubation (P=0.02) and ICU stay (P=0.04) were reduced. The clinical benefits associated with the EVADO may be due to better end-organ perfusion, lesser impairment of the coagulation and inflammatory reaction.
Interactive cardiovascular and thoracic surgery 01/2011; 12(4):591-5.