Aleks DEĞİRMENCİOĞLU, Ertuğrul ZENCİRCİ, Ahmet ARNAZ, A. Ümit GÜLLÜ, Muharrem KOÇYİĞİT, Şahin ŞENAY, Ahmet AKYOL, Cem ALHAN

Kalp cerrahisi yapılan hastalarda atriyal fibrilasyon tedavisinde kriyoablasyon uygulaması: Orta dönem sonuçlarımız

Amaç: Bu çalışmada kalp cerrahisi yapılan hastalarda eşlik eden argon bazlı kriyoablasyonun orta dönem sonuçları sunuldu. Çalışma planı: Ağustos 2014 - Mayıs 2016 tarihleri arasında 33 hastaya (17 erkek, 16 kadın; ort. yaş: 63.9 yıl; dağılım 45-82 yıl) eş zamanlı açık kalp cerrahisi sırasında atriyal fibrilasyon tedavisi için kriyoablasyon ile Maze işlemi uygulandı. On iki hastaya robotik cerrahi kullanıldı. Altta yatan patolojiye göre biatriyal veya izole sol atriyal ablasyon yapıldı. Ameliyat sonrası 3 ve 12. aylarda kardiyolog tarafından, ritim 12 derivasyonlu elektrokardiyografi, 24 saatlik Holter ile değerlendirildi ve atriyal fibrilasyon ile ilgili ilaçlar, inme veya diğer tromboembolik olaylar değerlendirildi. Bulgular: Taburculuk sırasında 30 hasta (%90.9) sinüs ritminde, üç hasta (%9.1) ise atriyal fibrilasyonda idi. Ameliyat sonrasında orta dönemde, kriyoablasyon üç hastada (izole sol atriyal fibrilasyonda n=2, %8.3 ve biatriyal ablasyonda n=1, %11.1) başarısız oldu. Hastalarda hastane mortalitesi ve inme, sepsis, diyaliz gerektiren renal yetmezlik ve uzamış solunum yetmezliği gibi majör ameliyat sonrası komplikasyonlar gelişmedi. Sonuç: Eş zamanlı cerrahi kriyoablasyon, diğer kardiyak cerrahi işlemler ile birlikte uygulandığında atriyal fibrilasyonun tedavisinde etkili bir yöntem olup, robotik cerrahi ile de çok düşük oranda atriyal fibrilasyon nüksü ile sonuçlanmaktadır.

Application of cryoablation for the treatment of atrial fibrillation in patients undergoing cardiac surgery: Our mid-term results

Background: In this study, we aimed to present mid-term results of concomitant argon-based cryoablation in patients undergoing cardiac surgery.Methods: Between August 2014 and May 2016, 33 patients (17 males, 16 females; mean age 63.9 years; range 45 to 82 years) underwent the Maze procedure using cryoablation for the treatment of atrial fibrillation during a concomitant open cardiac operation. Robot-assisted procedures were used in 12 patients. Biatrial or isolated left atrial ablation was performed according to the underlying pathology. The rhythm assessment with 12-lead electrocardiography and 24-hour Holter, and recordings of atrial fibrillation-related medications, stroke or other thromboembolic events were evaluated by the cardiologist at 3 and 12 months postoperatively.Results: Thirty patients (90.9%) were in sinus rhythm and three (9.1%) were in atrial fibrillation at the time of discharge. Cryoablation failed in three patients (n=2, 8.3% in isolated left atrial and n=1, 11.1% in biatrial group) following the operation in the mid-term. Among the patients, there was no in-hospital mortality and no major postoperative complications such as stroke, sepsis, renal failure requiring dialysis, and prolonged respiratory failure.Conclusion: Concomitant surgical cryoablation is an effective method for the treatment of atrial fibrillation, when performed concomitantly with other cardiac surgical procedures and results in very low atrial fibrillation recurrence, even in robotic surgery.

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