Totally thoracoscopic left atrial Maze: standardized, effective and safe

Interact Cardiovasc Thorac Surg. 2016 Mar;22(3):259-64. doi: 10.1093/icvts/ivv358. Epub 2015 Dec 23.

Abstract

Objectives: The totally thoracoscopic left atrial Maze (TT-Maze) is a relatively new surgical solution for the treatment of atrial fibrillation (AF). The procedure consists of a complete left atrial Maze, which is performed by video-assisted thoracoscopy with the use of radiofrequency ablation. We describe our rhythm results as well as our learning curve experience of the TT-Maze.

Methods: To evaluate the learning curve, all consecutive patients who underwent a TT-Maze and were operated by one surgeon (Bart P. Van Putte) were included in the study. The endpoint of surgery was sinus rhythm with a bidirectional block of the box and pulmonary veins.

Results: A total of 83 patients were included. Fifty percent of the patients had paroxysmal AF. The mean indexed left atrial volume was 44 ± 15 ml/m(2) and 38% of the patients had a previous catheter ablation for AF. During a mean follow-up of 10.9 ± 4.9 months, there were no major events. At latest follow-up, 82% of the patients did not have a single registration of AF or other atrial tachyarrhythmias longer than 30 s. Patients without AF were also free from anti-arrhythmic drugs in 90% of the cases, free from coumadins or direct oral anticoagulants in 63% of the cases and free from both in 58% of the cases.

Conclusions: After almost 1-year follow-up, the TT-Maze is proved to be a successful, safe and reproducible strategy for the treatment of all types of AF including patients with enlarged left atria and previously failed catheter ablation.

Keywords: Atrial fibrillation; Maze; Mini-Maze; Pulmonary vein isolation; Thoracoscopic ablation; Totally thoracoscopic Maze.

MeSH terms

  • Aged
  • Anti-Arrhythmia Agents / therapeutic use
  • Atrial Fibrillation / diagnosis
  • Atrial Fibrillation / physiopathology
  • Atrial Fibrillation / surgery*
  • Catheter Ablation / adverse effects
  • Catheter Ablation / methods*
  • Clinical Competence
  • Female
  • Humans
  • Learning Curve
  • Male
  • Middle Aged
  • Pulmonary Veins / physiopathology
  • Pulmonary Veins / surgery*
  • Recurrence
  • Retrospective Studies
  • Risk Factors
  • Thoracic Surgery, Video-Assisted* / adverse effects
  • Time Factors
  • Treatment Outcome

Substances

  • Anti-Arrhythmia Agents