Combined stentless mitral valve implantation and radiofrequency ablation

Background. The aim of this study was to evaluate the results of combined stentless mitral valve (SMV) replacement and intraoperative radiofrequency ablation for chronic atrial fibrillation (IRAAF) to restore physiologic hemodynamic function. Methods. Since July 1998 12 patients (72 +/- 4 years, 10 women, mitral stenosis/mitral incompetence 8/4, NYHA 3.3 +/- 0.4, CI 1.8 +/- 0.5) had SMV implantation and received additional IRAAF by inducing continuous left atrial lesion lines from the MV annulus to all four pulmonary veins and to the atriotomy. Results. The flexible SMV was implanted at the papillary muscles and at the annulus using a conventional (n = 6) or a minimally invasive approach (n = 6). Sinus rhythm was successfully restored in 10 of 12 patients with 6- and 12-months' follow-up; 2 required DDD-pacemaker implantation. However, in the early postoperative period several interventions including medical treatment (sotalol or amiodarone) in 9 and electrical cardioversion in 7 patients was required. Two patients required reinterventions: 1 cardioversion and I amiodarone medication after 3 and 6 months, respectively. At echocardiography the SR IV demonstrated good hemodynamic function and atrial contraction. Conclusions. Restoration of physiologic cardiac function by SMV implantation and IRAAF is advantageous and no further anticoagulation is required. (Ann Thorac Surg 2000;70:1080-2) (C) 2000 by The Society of Thoracic Surgeons.