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Ann Thorac Surg 1999;68:805-810
© 1999 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Initial experience with the radial incision approach for atrial fibrillation

^a Department of Cardiothoracic Surgery, Nippon Medical School, Tokyo, Japan

Address reprint requests to Dr Nitta, Cardiothoracic Surgery, Nippon Medical School, 1-1-5, Sendagi, Bunkyo-ku, Tokyo 113-8603, Japan
e-mail: nitta_takashi/surg2{at}nms.ac.jp

Presented at the Thirty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Antonio, TX, Jan 25–27, 1999.

Background. Surgery for atrial fibrillation (AF) is performed with the aim of restoring sinus rhythm and atrial transport function, and preventing thromboembolism. The radial incision approach (RIA), in which the atrial incisions radiate from the sinus node toward the atrioventricular annular margins and parallel the coronary arteries, was developed as an outgrowth of and an alternative to the maze procedure in order to preserve a more physiological activation sequence and the atrial transport function.

Methods. To determine whether the RIA is a promising procedure for AF, 23 patients who had undergone the RIA (n = 10) or the maze procedure (n = 13) for chronic AF associated with valvular heart disease were examined in terms of the postoperative cardiac rhythm and atrial transport function.

Results. AF was cured in 90% of RIA patients and 92.3% of maze patients (not significant). One patient in each group required pacemaker implantation for an insufficient sinus rate postoperatively. The RIA was technically easier than the maze procedure, because the incisions were more linear and there was no isolation incision or "T-shape" incision in the left atrium. The left atrial transport function, assessed by transthoracic Doppler echocardiography, was greater after the RIA than after the maze procedure, while the right atrial transport function was equally preserved by both procedures. The peak atrial filling/early filling waves of the flow-velocity spectra across the mitral valve was significantly larger after the RIA than after the maze procedure (0.58 ± 0.17 vs. 0.25 ± 0.07, p < 0.005). The left atrial filling fraction was significantly larger after the RIA than after the maze procedure (28.5% ± 5.0% vs. 15.1% ± 4.0%, p < 0.001).

Conclusions. RIA provides a greater atrial transport function, and thus may represent a physiological alternative to the maze procedure as a surgical procedure for AF.

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