Page 25 - ADD-ON ABLATION SURGERY IN PATIENTS WITH ATRIAL FIBRILLATION

undergoing RF ablation through a right-side thoracotomy approach. If these
results are confirmed, this approach has an important role to play in the treatment 1 of LAF.
Left-side thoracoscopic approach
Grandmougin and Tiffet138 presented a case of a 68-year old female with permanent LAF who, due to consequences resulting from chemotherapy and OAC, underwent left-side video-assisted thoracoscopic drainage associated with successful epicardial radiofrequency isolation of the PVs. On the basis of this experience, the authors raised the question of whether to perform ablation of both right and left PVs in the same operation rather than delaying an additional ablation of the controlateral side according to rhythmologic results.
Exclusion/excision of the left atrial appendage (LAA)
Excision or exclusion of the LAA is currently performed during surgical ablation of AF and is recommended in EHRA/HRS guidelines.
Recently, there has been great interest in development and assessment of endocardial and epicardial procedures for exclusion of the LAA139. Many of these approaches now use a stapler to exclude the appendage or, in some instances, endocardial suture exclusion. Nonetheless, Kanderian et al.140, demonstrated at transoesophageal echocardiography (TEE) that only 55 of 137 (40%) closures were successful and that a LAA closure occurred more often with excision (73%) than suture exclusion (23%) and stapler exclusion (0%, p > 0.001). In the available literature, the ligation/exclusion of the LAA was performed in 618 (83.6%) patients undergoing minimally invasive surgical ablation for LAF. The occurrence of perioperative cerebrovascular accident was low (0.32%)141-142 and comparable with the Cox–Maze procedure (0.5%)143. Alike, the occurrence of cerebrovascular accidents during the follow-up was low (0.64%) and this figure compares favourably with occurrence rates reported after the Cox–Maze operation143-144. However, notably, the percentage of patients with anticoagulant therapy was much lower in Cox–Maze (16.3%) compared with minimally invasive LAF patients (n = 214, 31.4%).
From our review, the procedure resulted to be safe. Indeed, among LAF patients undergoing minimally invasive surgical ablation and LAA ligation/excision, we found only one case (0.16%) of a serious complication related to tearing of the base of the LAA145.
Introduction
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