How I do it: simplified Cox-Maze IV via right mini-thoracotomy

Le résumé fourni par la source

Clinical vignetteA 59-year-old male suffered symptomatic long-standing persistent atrial fibrillation (AF).There were no relevant comorbidities except multiple failed transcatheter ablations.A moderate left atrium (LA) dilation and a right coronary dominance was detected pre-operatively.The patient underwent modified minimally invasive Cox-Maze IV surgical ablation. Surgical technique Preparation and expositionUnder general anesthesia, venous (right internal jugular and femoral veins) and arterial (femoral artery) cannulation for cardiopulmonary bypass (CPB) is achieved percutaneously.The right thorax is slightly lifted using an inflatable bag.A 4-5 cm anterolateral mini-thoracotomy is performed at the 3 rd intercostal space (ICS).The camera port is positioned at the 2 nd ICS at the anterior axillary line.The right pericardium is opened at least 2 cm above the phrenic pedicle to avoid nerve injury.Heparin is given and CPB commenced.The aorta is cross-clamped and cardioplegic solution delivered in antegrade fashion.The LA is widely opened towards the oblique sinus and extended towards the coronary sinus (CS).This reduces the length between the inferior part of the incision and the mitral annulus (MA).

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