The Annals of Thoracic Surgery, Vol 45, 495-504, Copyright © 1988 by The Society of Thoracic Surgeons
Surgical division of Wolff-Parkinson-White pathways utilizing the closed-heart technique: a 2-year experience in 47 patients
Y Mahomed, RD King, DP Zipes, WM Miles, EN Prystowsky, JJ Heger and JW Brown
Department of Surgery, Indiana University School of Medicine, Indianapolis 46223.
Kent bundle interruption for ventricular preexcitation has been
successfully accomplished utilizing several different surgical techniques.
The external closed-heart technique of Guiraudon combining surgical
dissection and cryoablation has been used to interrupt 52 accessory
pathways in 47 consecutive patients since May, 1985. The 35 male and 12
female patients ranged in age from 10 to 67 years (mean, 30 years). There
were 25 left free wall, 13 right free wall, 13 posterior septal, and 1
anterior septal accessory pathways. Preoperative and intraoperative
electrophysiological studies were performed in all patients to induce the
arrhythmia and localize all accessory pathways. The operation consisted of
dissection of the atrioventricular fat pad. Following this, the delta wave
and retrograde accessory pathway conduction disappeared, thereby indicating
successful pathway ablation. In 4 patients with right-sided accessory
pathways, interruption of the pathway required cryoablation. Cryolesions
(made with cryoprobe at -60 degrees C for two minutes) were created in the
region of the accessory pathway insertion. All accessory pathways were
successfully ablated without any deaths or heart block. Concomitant
surgical procedures were performed in 4 patients. Two patients required a
second operation the next day for an accessory pathway not found at the
initial operation. Three patients had postpericardiotomy syndrome, and 4
had recurrent atrial fibrillation requiring therapy. The remaining patients
have had no arrhythmia recurrence and have remained drug free after a
follow-up of 1 month to 22 months (mean, 12.5 months). We conclude that the
closed-heart technique of accessory pathway ablation is safe and
reproducible, obviates the necessity for aortic cross-clamping and
cardioplegic arrest, and allows instantaneous monitoring of conduction over
the pathway.
