A39 Session 11: Cardiovascular Disease Intervention: Afib cryo-ablation as a concomitant procedure to aneurysm repair

Abstract

Since the development of cryo-energy for surgical ablation of atrial fibrillation, the procedure has become safer and more effective as concomitant to coronary or valve surgery. However, it is still only performed in a fraction these cases when indicated, and less often in patients undergoing aneurysm surgery. We describe our experience in patients undergoing ascending aneurysm repair and concomitant surgical cryoablative atrial fibrillation MAZE. From January 2004 until November 2011, 40 patients underwent ascending aneurysm repair and surgical cryo-ablation at our institution and were retrospectively analyzed. Average age was 67.6 years (43–85) and nine (23%) patients were female. Preoperative, intraoperative, and postoperative variables including complications, rhythm success, and survival were analyzed. Aortic root replacement was performed in 23 (57.5%) and arch replacement with circulatory arrest in 18 (45%). An average of 5 lesions were performed. Each was performed for 60 s. All lesions achieved temperatures of −120 °C. At an average of 41.8 months, 81% of patients were in sinus rhythm, and 63% were in sinus rhythm off antiarrhythmic medications. Operative survival was 100%, with actuarial one and five year survivals of 97.5% and 93.1%, respectively. Kaplan–Meier analysis revealed improved overall survival in patients with rhythm success (log-rank test p = 0.037). Aortic aneurysm repair with concomitant Cryo-ablative MAZE is safe and efficacious despite the requirement for an already extensive procedure. Excellent short and long term survival can be achieved as can rhythm success rates similar to those quoted in the setting of other procedures. Successful restoration of sinus rhythm improves long term survival and should be considered in patients presenting with aortic aneurysm and atrial fibrillation.