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International Coronary Congress

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Concomitant Coronary Artery Bypass Surgery and Epicardial Box Lesion Ablation
Pavel Shilenko
FGBU FCVMT, Kaliningrad, Russian Federation

Objective With a combination of coronary disease and atrial fibrillation, many questions remain - how to treat, when CABG is needed, Coronary artery bypass grafting, and pulmonary vein isolation with bipolar clamp? Or coronary bypass and open the left atrium to maze 3 or 4? To increase the effectiveness of treatment of atrial fibrillation or to avoid cardioplegia and opening of the heart cavities? The purpose of the study is to determine the feasibility of performing epicardial ablation in CABG using a standard set of electrodes for thoracoscopic ablation.
Methods from 2018 to July 2021, we performed 26 coronary bypass grafting in combination with epicardial ablation at once. In all cases, the ablation «Dallas» lesion set was performed. 5 operations were performed according to the scheme: thoracoscopic ablation + MIDCAB and 21 operations through the sternotomy. From these 21 operations in 6 cases, the ablation and CABG were performed «off-pump», 2 operations «on-pump beating heart» and 13 operations, CABG on cardioplegia. 18 patients had a long-standing persistent atrial fibrillation. 18 were male. The average age is 64 years (54-81). 5 patients had isolated proximal LAD disease. 4 had a two-vessel and 17 had three-vessel disease. 2 ITA were used. If necessary, the vein was harvested by the "no-touch technique". An intraoperative ultrasound graft flow probe was performed. In all cases, the left atrial appendage ligation was performed.
Results The operation time was 186 min (+- 24min). The average time of ablation through sternotomy was 32 minutes (- +8 min). In 5 «off-pump» operations sinus rhythm was restored without cardioversion. In cases of CABG in cardioplegia, the sinus rhythm was restored after removing the clamp from the aorta. In the remaining 7 operations, cardioversion was performed. Complications such as heart attack and bleeding are not noted. Intensive care time was 18 hours (- +3.2). In 8 cases, freedom from atrial fibrillation was confirmed after 1 year. In other cases, at the moment there is a three-month follow-up. Catheter re-isolation was performed in four patients with atrial flutter. There was no need for coronary reintervention.
Conclusions Epicardial ablation during CABG is performed with the standard Atricure thoracoscopic ablation kit. The 3 months and 1-year follow-up freedom from atrial fibrillation do not differ from endoscopic treatment. But need to get a long-term follow-up.


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