EComment. Mini-partial heart autotransplantation for atrial fibrillation and mitral valve surgery

Abstract

It is very exciting to discuss this beautiful article by Pan et al. [1]. There is considerable documentation in the literature about the use of partial heart autotransplantation for a variety of purposes. My teacher, Arrigo Lessana in Aubervilliers, France, had begun to use partial cardiac autotransplantation in the spring of 1998 [2] for adequate visualization to reduce the size of the left atrium (LA). Later, when I came back to Mexico, I operated on three cases of mitral valve disease and chronic atrial fibrillation (AF) with giant LA from 2000 to 2001 [3]. All three cases had a spectacular outcome. After this very nice experience, I promptly realized that by sectioning only the superior vena cava (SVC) one can get an effective access to the whole LA. So I performed about 100 cases of surgical isolation of the pulmonary veins to treat AF in mitral valve disease [4]. But it is clear that this was not a left-sided maze, and the sinus rhythm conversion rate was lower than those reported by Cox et al. [5]. With all this experience, I made contact with Professor Jim Cox in 2012. After he emphasized the key aspects for successful completion of the Cox maze III 'cut-and-sew' procedure, I started to perform it by adding the transection of the SVC. This modification from the original technique can be termed as mini-partial heart autotransplantation. And this is just the point that I want to emphasize in this comment. Once the entire LA has been circumferentially divided and the SVC sectioned, the heart is lifted up and twisted towards the left side of the patient. I have found that this technique allows an extraordinary visualization of the mitral valve. Since the heart is twisted, the surgeon works from 'ground level'. I have performed 14 cases of the Cox maze III procedure and mitral valve surgery by means of mini-partial heart autotransplantation with an excellent outcome. Re-anastomosis of the SVC is performed in 5 to 10 minutes in a beating heart. No additional risks are added with this technique. I encourage cardiac surgeons to use this technique to make both mitral valve surgery and the Cox-maze III procedure more amenable. Conflict of interest: none declared