Search PubMed⌕ Search

Biomedical subjects

R Autschbach

Publications and source records attributed to R Autschbach.

At least 55 records · Page 3Linked to original sources
PubMed2000

[Robotic-guided techniques in heart surgery].

The rigid design of conventional endoscopic instruments with limited degrees of freedom has not allowed for endoscopic cardiac surgery. Using a surgical telemanipulation system that is operated from a master console, endoscopic coronary artery bypass grafting and mitral valve repair can be performed with high precision. Closed-chest cardiopulmonary bypass systems that allow cardioplegic cardiac arrest are required. After extensive experimental testing a telemanipulation system was used clinically.

Cardiac Surgical Procedures↗
PubMed1999

Prospectively randomized evaluation of stentless versus conventional biological aortic valves: impact on early regression of left ventricular hypertrophy.

BACKGROUND: The aim of this prospectively randomized study was to evaluate left ventricular hypertrophy and its regression after stentless versus conventional biological aortic valve replacement. METHODS AND RESULTS: From March 1996 through April 1998, 180 patients were prospectively selected; 106 patients received a stentless aortic valve (SAV), and 74 received a conventional stented bioprosthesis (CSB). Of these patients, 95% and 96%, respectively, had aortic stenosis. Their mean age was 72.3 and 74.8 years, and there were no significant differences in left ventricular function, preoperative pressure gradients, and NYHA functional status. Aortic annulus diameter indexes were comparable at 13.46 (SAV) versus 13.55 (CSB) mm (P=NS). Larger SAVs were implanted because of the oversizing technique. In-hospital mortality (n=3 and 1 for SAV and CSB) was not valve related. At follow-up, all patients were in NYHA class 1 or 2. Baseline end-diastolic left ventricular posterior wall thickness was 15.6 (SAV) and 14.8(CSB) mm (P=NS) and decreased to 11. 8 (SAV) and 13.2 (CSB) mm (P<0.05) at 6 months. Left ventricular mass index was 213 and 202 g/m(2) at baseline (P=NS), whereas after 6 months, it was 141 (SAV) and 170 (CSB) g/m(2) (P<0.05). CONCLUSIONS: Regression of left ventricular hypertrophy occurs in all patients after aortic valve replacement but is significantly enhanced after SAV implantation. This possibly is due to improved transvalvular hemodynamics.

Aged↗
PubMed1999

Early clinical results after stentless mitral valve implantation and comparison with conventional valve repair or replacement.

BACKGROUND: A new quadricusp stentless mitral bioprosthetic valve (QMV) is evaluated and compared with current standards. METHODS AND RESULTS: Since August 1997, 67 patients were prospectively evaluated: 23 patients received a QMV, 23 had mitral valve repair (MVR), and 21 received conventional mitral valve replacement (MVP). Patient age was 69+/-8, 64+/-10, and 62+/-9 years for QMV, MVR, and MVP treatment, respectively. The underlying pathology was mitral stenosis, incompetence, and mixed disease in a corresponding 8, 9, and 6 patients for QMV, 1, 22, and 0 patients for MVR, and 2, 12, and 7 patients for MVP. The papillary muscles were sufficient in all QMV cases to suspend the valve. Cross-clamp time was 59+/-19 minutes for QMV implantation. In-hospital mortality for QMV, MVR, and MVP was 1, 0, and 0 patients, respectively, and thoracotomy had to be performed again in 1, 1, and 2 patients, respectively (these outcomes were not valve related). At baseline transthoracic echocardiography, respective maximum flow velocities were 1.6, 1.4, and 1.7 m/s, and valve orifice area was 2.6, 3.5, and 3.4 cm(2). Mild transvalvular reflux was seen in 8, 7, and 2 patients; moderate reflux, in 1, 1, and 1 patients. Left ventricular ejection fraction was 52%, 54%, and 51% in the respective treatment groups. At follow-up, hemodynamic parameters had further improved in all groups. CONCLUSIONS: One year after clinical implantation, the QMV appears to function well and has no additional risks compared with MVR or MVP. The subvalvular apparatus is preserved by suspending the QMV at the papillary muscles; this arrangement is hemodynamically advantageous. Echocardiography reveals an excellent valve performance that resembles native mitral valve morphology and hemodynamic function. The QMV is a promising alternative for biological mitral valve replacement.

Aged↗
PubMed1999

Pain and quality of life after minimally invasive versus conventional cardiac surgery.

BACKGROUND: The aim of this study was to evaluate pain and quality of life after minimally invasive cardiac operations in comparison with conventional cardiac operations. METHODS: From October 1996 to May 1997 a total of 338 patients were interviewed daily using standard scoring systems (myocardial revascularization, n = 160; mitral valve reconstruction or replacement, n = 58; aortic valve replacement, n = 120). RESULTS: Regarding ventricular function and intensive care and hospital stay, there were no significant differences between groups. Pain decreased until the seventh postoperative day in all patients. Patients with a lateral minithoracotomy (minimally invasive revascularization and mitral valve operations) had lower pain levels from the third postoperative day onward. There were no differences in quality of life, postoperative wound healing, or stability of the bony thorax. CONCLUSIONS: In cardiac operations overall pain levels are relatively low. After minimally invasive procedures with lateral minithoracotomy, earlier mobilization is possible because of a better stability of the bony thorax, resulting in lower pain levels.

Aged↗
PubMed1999

Repair of cor triatriatum associated with partially unroofed coronary sinus.

A young patient with cor triatriatum, secundum atrial septal defect, persistent left superior vena cava, partially unroofed coronary sinus, and moderate tricuspid regurgitation was documented to have both a left-to-right shunt from the common pulmonary venous chamber to the right atrium and a right-to-left shunt from the partially unroofed coronary sinus to the left atrium. Resection of the membrane dividing the left atrium, closure of the atrial septal defect and the partially unroofed coronary sinus with pericardial patches, and a tricuspid annuloplasty resulted in an excellent hemodynamic result.

Child↗
PubMed1999

Aortic root reconstruction with preservation of native aortic valve and sinuses in aortic root dilatation with aortic regurgitation.

BACKGROUND: We assessed the results of a modified technique for aortic root reconstruction including preservation of the native aortic valve and sinuses. METHODS: A modified technique for reconstruction of the aortic root was devised in which the native aortic sinuses are preserved and remodeled, the diameter of the sinotubular junction is reduced, the ventriculoaortic junction is reinforced with a Dacron prosthesis, and the coronary ostia are reimplanted. Since January 1995, this modified operative technique was performed in 13 patients with a mean age of 54 +/- 21 years. The median grade of aortic regurgitation was 3; in 10 patients it was caused by dilatation of the sinotubular junction, and 3 had additional annuloaortic ectasia. RESULTS: The aortic crossclamping time was 61 +/- 18 minutes. In-hospital mortality was 2 of 13 (15. 3%) patients, both deaths being related to complications of aortic dissection. In 1 patient aortic regurgitation increased to grade 3, necessitating aortic valve replacement. At a mean follow-up of 2.1 years, the remaining 10 patients had stable aortic valve function with a median grade of regurgitation of 1. The mean New York Heart Association functional class was 1.2. CONCLUSIONS: Aortic root reconstruction with preservation of the native aortic valve and sinuses allows symmetric reconstruction of the aortic sinuses and adaptation of the diameters of the sinotubular and ventriculoaortic junctions, thus optimizing aortic valve function. Moreover, it prevents contact of the aortic valve leaflets with the Dacron graft, which may enhance the durability of the repair.

Adolescent↗
PubMed1999

Resection of a right atrial metastatic melanoma with unknown origin of primary tumor.

Cardiac involvement of malignant melanoma is generally part of a widespread tumor dissemination, which is mostly multifocal. Hence the disease is usually not amenable to surgical intervention. We report successful resection of a large intracavitary melanoma to the right atrium, the primary origin of which was unknown. The right atrium was reconstructed with an autologous pericardial patch. At 12-month follow-up the patient remains asymptomatic.

Echocardiography, Transesophageal↗
PubMed1999

Angiographic results after minimally invasive coronary bypass grafting using the minimally invasive direct coronary bypass grafting (MIDCAB) approach.

OBJECTIVE: The aim of the study was to evaluate the early and mid-term angiographic results after minimally invasive coronary bypass grafting using an 'off-pump' technique via a lateral minithoracotomy. METHODS: In 221 out of 271 patients (81.5%) who underwent minimally invasive direct coronary bypass grafting (MIDCAB) the quality of the internal thoracic artery (ITA)-graft and the anastomosis was evaluated by conventional coronary angiography between the 2nd and 6th postoperative day (POD). A subgroup of 130 patients (47.9%) of the initial cohort were repeatedly controlled by angiography 6 months later. RESULTS: The early postoperatively patency rate of the grafts was (96.8%). Moderate anastomotic stenosis between 50 and 75% was found in 13/221 (5.8%) patients, whereas severe stenosis of more than 75% was seen in 10/221 (4.5%) and occlusion of the graft in 3/221 (1.3%) patients. A stress-ECG was performed in patients with a severe stenosis to provoke ST-segment changes or clinical findings of myocardial ischemia. A positive stress test was found in 4/221 patients (1,8%). Early re-intervention was required in 7/221 (3.1%) patients. After 6 months, angiographic follow-up revealed a patency rate of (95.4%). Of 130 patients 5 (3.8%) presented with moderate anastomotic stenosis, whereas 3/130 (2.0%) patients showed a severe stenosis with one patient (0.7%) having myocardial ischemia during stress test. Occlusion of the graft was seen in 3/130 patients (2.3%). During follow-up, 4/130 (3.0%) patients underwent re-intervention. A comparison between early postoperative and 6-months angiogram revealed a decrease or a disappearance of the severity of the stenosis in 4/15 patients (26.6%). CONCLUSION: Since stenosis of the anastomosis may occur after minimally invasive, beating heart coronary bypass grafting, postoperative angiography should be performed to provide quality control and to guide appropriate further treatment. The latter is necessary if the stenosis is accompanied by reduced run-off and evidence of myocardial ischemia during stress test. An improvement of early stenosis at the anastomosis may be expected in more than 25%.

Adult↗
PubMed1999

The evolution of minimally invasive valve surgery--2 year experience.

OBJECTIVES: The aim of the study was to evaluate the evolution of Port-Access minimally invasive mitral valve surgery to a robot assisted video assisted solo surgery approach. METHODS: One hundred and twenty-nine patients with non-ischemic mitral valve disease underwent 3D-video assisted mitral valve surgery via a 4 cm right lateral minithoracotomy using femoro-femoral bypass and endoaortic clamping. Transcranial Doppler and continuous transesophageal echocardiography were used to monitor placement and positional stability of the endoclamp. After the initial series (group I, n = 62), a simplified solo surgical technique using voice controlled robotic assistance for videoscope guidance was used in the last 67 patients (group II). RESULTS: After an initial learning curve and modifications of catheter design, the procedure could be steadily redefined and simplified. In the last 67 patients, the procedure was completed without the need for an additional assistant as 'solo surgery'. The mitral valve was repaired in 72 and replaced in all other patients. Duration of bypass and clamp time steadily improved during our study and in the most recent 67 patients average 107 +/- 34 and 48 +/- 16 min, respectively. The voice controlled robotic arm (AESOP 3000, Automated Endoscope System for Optimal Positioning) provided a stable and precise video image with excellent exposure of all valvular and subvalvular structures. Hospital mortality was high in the early series (mean survival 88.7% at 804 +/- 35 days; 95% CI: 735-873) and partially procedure related (aortic dissection in two patients). In group II, hospital mortality has declined to 3.0% (mean survival 97.0% at 568 +/- 12 days; 95% CI: 553-600). CONCLUSION: Port-Access minimally invasive mitral valve surgery has evolved to be a reliable video assisted technique with reproducible results. Surgery can now be performed almost in the same time as with conventional techniques. Robotic assistance has enabled a solo surgery approach.

Aged↗
PubMed1999

Indication and patient selection in minimally invasive and òff-pump' coronary artery bypass grafting.

BACKGROUND: The selection criteria to perform 'off-pump' coronary bypass (OPCAB) grafting are not well defined. The aim of this presentation is to outline the indications and the patient selection on the basis of 2 years experience with 572 OPCAB procedures. MATERIALS AND METHODS: From November 1996 minimally invasive coronary bypass grafting was performed in 406 patients using a limited minithoracotomy for single left anterior descending artery (LAD) revascularization (group A). In 166 patients full sternotomy and OPCAB grafting for single or multiple vessel revascularization was performed (group B). RESULTS: In group A the procedure could be performed 'off-pump' together with a limited thoracotomy in 406 out of 457 patients (88.8%) who were scheduled for single graft revascularization to LAD. Exposure and quality of the LAD was good in 308/406 (76.0%) of the patients. The decision for sternotomy was made for different preoperative characteristics of these patients: Obese female patients 16/457 (3.5%), angiographic evidence of an intramyocardial running LAD 6/457% (1.4%), diffusely diseased and small LAD 11/457 (2.4%) severe COPD 3/457 (0.7%), unstable angina 11/457 (2.4%), emergency revascularization after failed PTCA 4/457 (0.8%). In 315/406 (77.8%) of the minimally invasive direct coronary artery bypass (MIDCAB)-patients exposure and quality of the LAD was good, in 97/406 (22.2%) moderate or even bad. In the latter subgroup stenosis free anastomosis was reduced (86.5%) compared to the subgroup of good exposure and quality with 98.3%. In group B selection for sternotomy and 'off-pump' procedure was made in 117/166 (70.4%) patients with a normal preoperative status (stable angina, ejection fraction > 35%) and with coronary lesions amenable for beating heart surgery (proximal RCA lesion > 80%, not calcified and well defined POD and marginal branches). In 49/166 (29.5%) decision for 'off-pump' procedure was made on the basis of a potential risk for cardiopulmonary bypass (CPB) such as acute myocardial infarction in 10/166 (6.0%), reduced ventricular function with EF < 35 in 28/166 (16.9%), calcified ascending aorta 4/166 (2.4%) or concomitant diseases 7/166 (2.5). CONCLUSION: To maintain excellent results after single LAD revascularization using the MIDCAB-approach, appropriate patient selection is crucial. Indication for sternotomy and 'off-pump' single LAD revascularization should made in those patients excluded for MIDCAB and in patients scheduled for multiple vessel-CABG who are at high risk for CPB (concomitant pulmonary, renal, neurological diseases or severely impaired left ventricular dysfunction) and have suitable target coronary arteries in term of location and quality.

Adult↗
PubMed1999

Experimental effects of cardiomyoplasty on stressed normal left ventricle in sheep.

OBJECTIVE: Several basic mechanisms of cardiomyoplasty were discussed in the last years, but the definite underlying mechanism is still unknown. The aim of the present study was to determine the effects of cardiomyoplasty on pressure volume loops of the non-failed left ventricle under different myocardial working conditions. METHODS: We performed cardiomyoplasty in eight female sheep after conditioning of the left latissimus dorsi muscles. To simulate different stress conditions we used myocardial stimulation up to 150/min and an increased afterload up to 140 mm Hg. The changes of left ventricular pressure and volume, aortal pressure and aortal flow were registered and analyzed. RESULTS: We found a significant decrease direct cardiomyoplasty effects during simulated stress conditions with increased heart rate up to 150/min and an increased afterload up to 140 mm Hg. We have seen direct effects in the non-failing hearts at rest only. CONCLUSIONS: These findings do not favor the concept of direct cardiomyoplasty-induced improvement of cardiac function under stress conditions. It seems that the conditioned and transformed skeletal muscle already under normal perfusion conditions in normal hearts is not able to generate enough force for an effective contraction under stress conditions. We conclude that the mechanism of cardiomyoplasty can not be explained by a direct effect of muscular support alone but results also from recovery of failed myocardium.

Animals↗
PubMed1999

Computer-enhanced mitral valve surgery: toward a total endoscopic procedure.

The aim of the study was to develop a computer-enhanced, video-assisted approach for mitral valve repair as a potential step toward a complete endoscopic procedure. In 10 patients with nonischemic mitral valve insufficiency, computer-enhanced telemetric mitral valve repair using the Intuitive surgical telemanipulation system was performed. A femorofemoral bypass was initiated using Port-Access (Heartport, Redwood City, CA) cannulation. A small minithoracotomy was made in the right 4th intercostal space, and a custom-made rib retractor was placed. The pericardium was opened manually, and four traction stay sutures were placed to enhance exposure. After endoaortic balloon clamping, the left atrium was opened and stabilized. The end-effectors were placed in the left atrium through two ports (3rd ICS and 6th ICS, midaxillary line). A 30 degrees three-dimensional (3D)-videoscope angled up was placed through the incision. Mitral valve repair was then performed remotely from the surgical console. This included inspection of the valve, leaflet resection, leaflet repair, and ring implantation. After completion of the repair and testing of the valve, the end effectors were withdrawn, and the left atrium was closed manually using standard endoscopic instruments (Heartport). In all but 1 patient, successful repair, including quadrangular resection, chordal shortening, Whooler-plasty, and Alfieri-plasty, could be accomplished using the computer-enhanced telemanipulation system. A partial ring was implanted in 6 patients and a complete ring was implanted in 3 patients, respectively. Time for surgery, CPB, and clamp time were 170 to 330 minutes (median, 185 minutes), 140 to 220 minutes (median, 149 minutes), and 78 to 133 minutes (median, 94 minutes), respectively. In one patient, intraoperative transesophageal echocardiography (TEE) showed insufficient repair, a second surgery was performed via an enlarged left thoracotomy. One patient with recurrent mitral insufficiency had to have a second surgery on postoperative day 3 for a torn-out ring. Median time of hospitalization was 8 days. At 3 months follow-up (completed in 7 patients), all patients had improved clinically. Computer-enhanced mitral valve repair is feasible and can be performed with good functional results. The telemanipulation system offers the potential for true endoscopic mitral valve repair. However, surgical time is prolonged, and a learning curve has to be overcome.

Aged↗
PubMed1999

Coronary bypass grafting without cardiopulmonary bypass--technical considerations, clinical results, and follow-up.

BACKGROUND: Coronary bypass surgery can be performed less invasively by avoiding cardiopulmonary bypass (CPB). We present our early 'off pump' coronary bypass surgery experience in combination with a minithoracotomy or sternotomy. METHODS: Between 11/1996 and 12/1997 312 patients were included in a prospective study, 223 (Group A) underwent an antero-lateral minithoracotomy (MIDCAB) and 89 (Group B) had a full sternotomy (OPCAB). ITA harvesting and anastomosis was performed under direct vision in all cases. Different devices for local mechanical immobilization were used to perform the anastomosis. RESULTS: In 212 patients of group A revascularization was by a single ITA graft and in 11 patients by a double graft using the radial artery as a T graft. Conversion to sternotomy and cardiopulmonary bypass was necessary in 12 (5.3%) patients. Intraoperative myocardial infarction was observed in 5 patients (2.2%). Early-postoperative reoperation due to graft failure was necessary in 5 patients (2.2%). Mortality was 0.4% (one patient). The early postoperative graft patency rate was 97.1% as confirmed by angiography. In group B, 25 patients had single graft and 64 patients multiple graft revascularization. Intraoperative conversion to CPB was necessary in 10 patients (11.2%). Intraoperative myocardial infarction occurred in 1 patient (1.1%), postoperative low output syndrome in 2 patients (2.2%). Early postoperative reoperation due to graft failure was necessary in 1 patient (1.1%). Mortality was 1.1%. Angiographic control of 48 patients after 6 months confirmed a patency rate of 92.6%. CONCLUSION: Coronary bypass surgery without using cardiopulmonary bypass is safe to achieve good early and mid-term results. MIDCAB is a minimally invasive technique. Experienced surgeons should be ready to compete with PTCA techniques.

Cardiopulmonary Bypass↗
PubMed1999

Effectiveness of different anticalcification treatments for stentless aortic bioprostheses.

BACKGROUND: New anticalcification treatments for stentless bioprostheses have not yet been compared independently. MATERIAL AND METHODS: The No-reacts (Biocor), AOA (Medtronic Freestyle), and BiLinx (SJM Toronto SPV II) methods were studied and compared with a control group. Aortic valve leaflet and aortic root tissue was subcutaneously implanted in 60 male, 21-days-old Sprague-Dawley rats. Calcium content was quantified using inductively coupled plasma spectrophotometry. RESULTS: No infections occurred. Low levels of calcium were measured in aortic valve leaflet tissue for all methods (0.4 to 1.5 mg/g dry weight) in comparison to the control group (225 mg/g), p < 0.01. Calcification of aortic root tissue was low in the Bilinx group (2.4 mg/g, p < 0.01), whereas calcium levels were high in all other groups (104 to 127 mg/g). CONCLUSIONS: Calcification of aortic valve leaflets was significantly reduced by all new anticalcification treatments, whereas aortic root calcification was only reduced by inhibition of cellular calcification (BiLinx). Maximum anticalcification properties of both leaflet and aortic root are important, as these are considered a functional unit in stentless bioprostheses.

Aluminum Chloride↗
PubMed1999

Quadrileaflet stentless mitral valve replacement.

BACKGROUND: The study evaluates clinical results and hemodynamic parameters one year after implantation of a stentless quadrileaflet mitral valve (QMV). METHODS: Since August 1997 28 patients received the QMV, patient age was 69 +/- 8 years; 13 had predominant mitral stenosis and 15 incompetence, preoperative NYHA functional class was III or IV and cardiac index 1.8 +/- 0.6 L/min/m2. RESULTS: Surgery was performed using a conventional (25) or a minimally invasive approach (3). 20 patients received a medium and 8 a large-size prosthesis, crossclamp time was 58 +/- 19 min. Additional procedures were myocardial revascularization in four, tricuspid repair in two, and left-atrial radiofrequency ablation to restore sinus rhythm in six patients. Perioperative mortality (1) was not valve-related. All other patients were discharged on time. At postoperative, 6-, and 12-months follow-up mean transvalvular pressure gradients were 4.2 +/- 1.5 / 4 +/- 0.9/ 3.8 +/- 1.4 mmHg and mitral valve orifice area index was 1.5 +/- 0.3 / 1.6 +/- 0.3 / 1.6 +/- 0.4, NYHA class was I or II. CONCLUSIONS: The QMV is well suited for mitral valve replacement. The anulo-ventricular continuity is preserved and the QMV function resembles native mitral valve function. If its performance is maintained in the long term the QMV may be the mitral prosthesis of choice.

Aged↗
PubMed1999

Antiarrhythmic surgery for treatment of atrial fibrillation--new concepts.

Curative treatment of atrial fibrillation is one of the main challenges of todays electrophysiology. The ideal treatment strategy should be effective, safe, and easy to apply to allow a widespread use. In addition, curative treatment should not only aim on the restoration of sinus rhythm but also restore mechanical atrial function to improve hemodynamics thereby avoiding anticoagulation. With respect to percutaneous catheter ablation no treatment concept with proven efficiency to cure chronic permanent atrial fibrillation is currently available. Surgical techniques such as the Corridor operation and the left atrial isolation procedure have been shown to effectively store sinus rhythm but these procedures do not restore biatrial transport function. Cox's Maze procedure is highly effective, however, it is an extensive and very time consuming technique which precludes the widespread application of this operation. Thus, new intraoperative treatment concepts are currently under intense clinical investigation. Most new concepts aim on the application of contiguous radiofrequency-induced lesion lines in the atria. Some of the new treatment strategies are based on the replacement of the surgical incisions of the Maze procedure using inrtraoperative radiofrequency coagulation thereby preventing functional determined reentrant circuits. Other new concepts aim on the induction of contiguous atrial lesion lines to eliminate anatomical determined atrial reentrant circuits. The main advantage of these new concepts when compared to the Maze procedure is a significantly shorter treatment time of approximately 20 minutes. In addition, some treatment strategies can also be applied in conjunction with minimally invasive cardiac surgery. The initial results reported with application of new treatment concepts indicate that approximately 60-80% of patients operated on can be cured from atrial fibrillation. Randomised studies with these new treatment strategies are necessary to validate the results and to outline which treatment concept may prove superior to others. Based on the progress made, it can be expected that intraoperative ablation of chronic permanent atrial fibrillation will become an important curative treatment strategy.

Atrial Fibrillation↗
PubMed1999

Intraoperative radiofrequency ablation of chronic atrial fibrillation: a left atrial curative approach by elimination of anatomic "anchor" reentrant circuits.

INTRODUCTION: The percutaneous approach to radiofrequency (RF) catheter ablation for curative treatment of atrial fibrillation (AF) is an investigational technique, and the optimal composition of lesion lines is unknown. We tested an intraoperative RF ablation concept with elimination of left atrial anatomic "anchor" reentrant circuits. METHODS AND RESULTS: In 12 patients with an indication for valve surgery and chronic AF, a right atrial-transseptal approach was chosen for access to the left atrium. AF had been present for 4.3 +/- 3.9 years; the left atria measured 56 +/- 7 mm. Under direct vision, contiguous lesion lines were placed endocardially with temperature-guided RF energy applications for treatment of AF with a specially designed probe. The lesion lines were placed between the mitral annulus and the left lower pulmonary vein, further to the left upper pulmonary vein, from there to the right upper pulmonary vein, and finally to the right lower pulmonary vein. The antiarrhythmic ablation procedure lasted 19 +/- 4 minutes. One patient died postoperatively of low cardiac output. During follow-up of 11 +/- 6 months, chronic AF was ablated successfully in 9 of 11 patients (82%). Six patients were in stable sinus rhythm or intermittent pacemaker rhythm, and three patients were in sinus rhythm with intermittent atypical atrial flutter. CONCLUSIONS: Intraoperative RF energy application for induction of contiguous lesion lines is feasible. Elimination of anatomically defined "anchor" reentrant circuits within the left atrium prevented chronic AF in > 80% of the patients treated. Intraoperative validation of lesion line concepts for curative treatment of AF may be transferred to percutaneous ablation techniques.

Aged↗