Combining robotic mitral valve repair and microwave atrial fibrillation ablation: techniques and initial results

Left atrial microwave ablation for atrial fibrillation has become popular for isolating autonomous atrial foci. Previously, mitral valve repairs (MVP) with atrial fibrillation ablation have been performed through sternotomy. We present a technique that combines robotic MVP with left atrial fibrillation ablation.

Through a 4-cm right minithoracotomy and using cardiopulmonary bypass, the transverse and oblique sinuses are accessed. A Flex-10 microwave catheter is passed around the pulmonary veins, and after weaning from cardiopulmonary bypass, peripulmonary vein microwave ablations are performed. After cardioplegic arrest, the da Vinci system is used to manipulate the catheter to create endocardial lesions around the left atrial appendage. Another endocardial lesion is made connecting the pulmonary venous line with the mitral annulus near P3. The left atrial appendage is closed, and the MVP performed robotically. Data are expressed as mean +/- standard deviation.

Sixteen patients underwent this combined procedure, with 80% returning to a normal sinus rhythm at 6 weeks and 73% remaining in normal sinus rhythm at 6 months. Only 1 patient was in atrial fibrillation at 6 months. The ablation procedure added 42 +/- 16.1 minutes to a robotic MVP. The average length of hospital stay was 6.3 +/- 2.2 days, 1.3 days longer than the mean of the prior 50 consecutive robotic MVP patients without a concomitant ablation.

Robotic microwave ablation during robotic MVP is a safe, effective way to resolve atrial fibrillation. These methods offer a promising prelude to the combined totally endoscopic treatment of atrial arrhythmias and mitral insufficiency.