Ann Thorac Surg 2007;84:357-358
© 2007 The Society of Thoracic Surgeons
Correspondence
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Vinay Badhwar, MD, MS
Tampa Bay Heart Institute, Cardiac Surgical Associates, 6006 49th St North, Suite 310, St. Petersburg, FL 33709
(Email: vbadhwar{at}heartsurgery-csa.com).
To the Editor:
I would like to thank Dr D’Ancona and colleagues [1] for their favorable and insightful comments [1] regarding our article [2]. We agree with Dr D’Ancona and colleagues [1] that surgical treatment of atrial fibrillation (AF) should not be limited to the pulmonary veins, especially in patients with large left atria requiring concomitant mitral surgery. It is known that left atrial enlargement is an independent predictor of surgical ablation failure [3], and yet currently there exists a multitude of surgical techniques that frequently describe application of one or more ablative devices while not consistently addressing left atrial size reduction.
The objective of our article was to examine a simplified technique that combined left atrial reduction with the use of only one ablative device, applied to only the left atrium, on a homogeneous group of patients with permanent AF undergoing concomitant mitral surgery. This method begins with dissecting the interatrial groove to the interatrial septum prior to entry into the roof of the left atrium. Once the complete ablation and left atrial appendage closure described [2] is complete, this first step allows for easy resection of the excessive left atrial tissue by extension of the standard atriotomy to the midpoint between the right and left inferior pulmonary veins, permitting a simple crescent-shaped excision from the roof of the left atrium to the end of the atriotomy to complete the reduction. We have found that p wave atrial contractile function returns in the majority of patients between the first and third postoperative month. Although there can be many methods to atrial reduction, we have found this "resect to remodel" approach uses the standard atriotomy in a reproducible manner to achieve a marked and consistent reduction in atrial volume along with circumferential four-vein isolation without additional suture lines or risk associated with posterior wall distortion of the pulmonary veins.
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References
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- D’Ancona G, Santise G, Sciacca S, Pirone F, Pilato M. Simplified left atrial volume reduction and modified maze procedure as treatment for permanent atrial fibrillation during concomitant mitral valve surgery Ann Thorac Surg 2007;84:357.[Free Full Text]
- Badhwar V, Rovin JD, Davenport G, et al. Left atrial reduction enhances outcomes of modified maze procedure for permanent atrial fibrillation during concomitant mitral surgery Ann Thorac Surg 2006;82:1758-1764.[Abstract/Free Full Text]
- Chen MC, Chang JP, Chang HW. Preoperative atrial size predicts the success of radiofrequency maze procedure for permanent atrial fibrillation in patients undergoing concomitant valvular surgery Chest 2004;125:2129-2134.[Medline]
Related Article
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Simplified Left Atrial Volume Reduction and Modified Maze Procedure as Treatment for Permanent Atrial Fibrillation During Concomitant Mitral Surgery
- Giuseppe D’Ancona, Gianluca Santise, Sergio Sciacca, Francesco Pirone, and Michele Pilato
Ann. Thorac. Surg. 2007 84: 357.
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