Radiofrequency Ablation Of Atrial Fibrillation With Mitral Valve Replacement Under Totally Thoracoscopic Surgery

Objective To investigate the feasibility、safety and effectiveness of radiofrequency ablation of atrial fibrillation during mitral valve replacement under totally thoracoscopic surgery.Methods A retrospective study was carried out to collect the data of 114 patients with rheumatic mitral disease and atrial fibrillation who underwent mitral valve replacement and radiofrequency ablation at the same time from January 2014 to October 2018 in the department of cardiovascular surgery of Sichuan Mianyang 404 hospital.The patients were divided into the totally thoracoscopic surgery group(n=54)and the median sternotomy group(n=60)according to the different surgical methods.The perioperative、postoperative short-medium-term data of the maintenance of sinus rhythm、left atrial diameter、ejection fraction(EF)and complications were collected to be compared.Results All patients were successfully completed the operation without death.In the postoperative follow-up,3 cases(5.6%)were lost in the totally thoracoscopic group,4 cases(6.7%)in the median sternotomy group.Finally,107 cases were included in the study,including 51 cases in the totally thoracoscopic group and 56 cases in the median sternotomy group.In terms of bleeding volume,induced flow,ventilator assisted breathing time,hospital stay and incision length,the difference between the two groups were statistically significant(P<0.05),the totally thoracoscopic surgery group was better than the median sternotomy group,and the difference was statistically significant.In terms of cardiopulmonary bypass time,the totally thoracoscopic surgery group was longer than the median sternotomy group,and the difference was statistically significant(P<0.05);the radiofrequency ablation time of the totally thoracoscopic surgery group was longer than that of the median sternotomy group,and the difference was statistically significant(P<0.05);there was no significant difference in the total operation time,aortic occlusion time,postoperative complications、EF、left atrial diameter、sinus rhythm maintenance and other aspects(P>0.05).There were no events such as atrioventricular block,pulmonary vein stenosis,atrioesophageal fistula,coronary artery injury,stroke and hemorrhage.Conclusion There is no significant difference in the maintenance rate of sinus rhythm after thoracoscopy compared with that after median sternotomy,which indicates that the ablation effect of AF under the totally thoracoscopic surgery is equivalent to that of median sternotomy;The time of cardiopulmonary bypass and radiofrequency ablation in the totally thoracoscopic surgery group was longer than that in the median sternotomy group,but the postoperative complications did not increase,and the trauma,bleeding volume and induced flow were reduced,the time of ventilator assisted respiration and hospitalization were shortened,the left atrial diameter was significantly reduced and the EF was increased.It has good safety and effectiveness,and it is worthy of clinical application.