Minimally invasive approach to surgical treatment of aortic valve defects and atrial fibrillation

Aim: to determine the possibility of performing and evaluate the safety of simultaneous surgical treatment of aortic valve disease through partial sternotomy and thoracoscopic treatment of atrial fibrillation.

Materials and Methods: From December 2022 to March 2023, four aortic valve replacement operations were performed at the FSBI Federal Center for High Medical Technologies of the Ministry of Health of the Russian Federation, Kaliningrad by upper median partial sternotomy to the 4th intercostal space in combination with left atrial thoracoscopic epicardial ablation and tourniquet left atrial appendage ligation. All patients were female, a mean age of 71.4 years, concomitant diagnosis of obesity and an average body mass index of 35.2. In three cases, a biological aortic valve prosthesis was implanted, in one mechanical one. For the treatment of atrial fibrillation, bilateral thoracoscopic ablation of the left atrium was performed. Double tourniquet ligation was performed to exclude the left atrial appendage from the blood flow.

Results: mean aortic cross-clamping time was 42 minutes, cardiopulmonary bypass time was 51 minutes. The duration of the stage of thoracoscopic ablation is 124 minutes, valve replacement is 154 minutes. All patients were transferred to the intensive care unit without AF. In two cases, temporary pacemaker support was required for 4 hours after surgery. The mean ventilatory time in the ICU was 154 minutes. All patients had a smooth postoperative period without atrial tachyarrhythmias. Hospitalization time was 10-14 days.

Conclusion: Our work has shown the possibility of performing two minimally invasive treatments at the same time. The immediate results have allowed us to expand the indications for various combinations of types of operations and treatments.

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