Objectives: Minimally invasive access is the standard approach for mitral valve surgery in specialized heart centers. Further, concomitant surgical ablation and LAA clipping is an established procedure for patients with atrial fibrillation (AF), which can be also performed in a minimally invasive setting. We therefore analyzed the safety and efficacy of surgical cryoablation and LAA clipping in minimally-invasive mitral valve surgery using 3D endoscopy.
Methods: Between 01/2016 and 06/2018, a total of 44 patients received a left-atrial cryoablation during minimally invasive mitral valve surgery and served as our primary study cohort. Additional LAA occlusion using the Atriclip was performed in 41 patients. Rhythm monitoring was performed by 24h-Holter ECG. Primary endpoint of the study was freedom from AF at 12 months of follow-up.
Result: Mean age of the studied cohort was 66.2 ± 9.9 years, 51.0% were male and the mean duration of AF was 4.8 years. 26 (59%) patients had persistent or long-standing persistent AF. There were no ablation-related complications and no perioperative death. One-year survival rate was 95.5% Successful intraoperative LAA closure was seen in all patients. Permanent pacemaker implantation rate during follow-up was 6.8%. Freedom from AF at 12 months follow-up was 75.0%. There was a higher success rate in patients with paroxysmal AF (83.3%), compared with patients with persistent AF (69.2%) but without statistically significant difference (p = 0.482)
Conclusion: Surgical Cryoablation in combination with LAA clipping is safe and feasible during minimally-invasive mitral valve surgery using 3D-endoscopy. The standardized left-atrial ablation and LAA clipping results in excellent rates of freedom from AF during 12 months of follow-up.
