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Bilateral Video Assisted Thoracoscopic (VAT) Approach for Pulmonary Vein Isolation (Minimally Invasive Maze procedure) in Patients with Isolated Atrial Fibrilation
Reza Khodaverdian, Thomas J. Sewyer, Vasant Khachane, Mark Marieb
Hospital of Saint Raphael, New Haven, CT

Objective: VAT approach for bilateral pulmonary vein isolation has minimized the operative trauma and can be curative in selected patients with isolated atrial fibrilation. We reviewed our data to evaluate the safety and effectiveness of this technique.
Design: Chart-review
Setting: Community Hospital
Patients: Charts of patients who underwent VAT bilateral pulmonary vein isolation for isolated atrial fibrillation were reviewed.
Interventions: A bipolar radiofrequency device (Atricure Inc., Westchester, OH) is used to create transmural lines of block. Left atrial appendage was excised in all of our patients.
Main Outcome Measures: Study endpoints are rhythm at 3 and 6 months post-op. Also, procedure related mortality and morbidity were evaluated.
Results: Between May of 2005 and February of 2007, 23 patients underwent mini maze procedure in our institution. Of these, 14 were male and 9 female with average age of 60.8 years (range 38-77 years). Mean duration of atrial fibirilation were 42 +/- 38.8 months. Atrial fibrillation was paroxysmal in 12, persistent in 3, and permanent in 8 patients. There was not any mortality or conversation to an open procedure in this group. Procedure related morbidity (4/23, 17%) were 2 lung herniations, one empyema, and one left diaphragmatic paralysis. We only analyzed data from patients with 6 months follow up. In this group, normal sinus rhythm achieved in 65% (11/17) three months post-op. Six months follow up showed that 70% (12/17) were in normal sinus rhythm. In the subgroup of patiets with paroxysmal atrial fibrillation, we achieved 100% conversion to normal sinus rhythm at 3 and 6 months.
Conclusions: Mini-maze procedure is s safe and effective alternative in selected group of patients with isolated atrial fibrillation.


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