Minimally invasive cardiac surgery for atrial fibrillation complicated by coronary artery disease: combination of video-assisted pulmonary vein isolation and minimally invasive direct coronary artery bypass

Abstract

Here we report a minimally invasive cardiac surgery procedure without sternotomy combining video-assisted bilateral pulmonary vein isolation and minimally invasive direct coronary artery bypass as treatment for atrial fibrillation complicated by coronary artery disease. The patient's chest was accessed through a left anterolateral thoracotomy over the fourth intercostal space, and the left internal thoracic artery (LITA) was harvested under direct vision. The left pulmonary veins were isolated electrically by a bipolar radiofrequency clamp. Subsequently, the harvested LITA graft was anastomosed to the left anterior descending artery. Right pulmonary vein isolation was then performed through a small thoracotomy at the right fourth intercostal region in the same manner as the left side. A linear block on the left atrial roof, connecting the lesions encircling the left and right pulmonary veins, was created from both sides by a pen-like bipolar radiofrequency.

Unilateral left-sided thoracoscopic ablation of atrial fibrillation concomitant to minimally invasive bypass grafting of the left anterior descending artery

“…Totsugawa et al [ 22 ] described in a case report a technique combining surgical AF ablation and LAD revascularization. There are 2 important differences between their technique and the technique described in the current manuscript: surgical AF ablation was performed via unilateral thoracoscopy compared to bilateral anterolateral thoracotomy and LIMA harvesting was robot-assisted compared to under direct vision.…”