Skip to main content
Erschienen in: Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 6/2020

13.11.2020 | Vorhofflimmern | CME

Kombinierte chirurgische Therapie des Vorhofflimmerns

verfasst von: Prof. Dr. med. Thorsten Hanke, M. Lass

Erschienen in: Zeitschrift für Herz-,Thorax- und Gefäßchirurgie | Ausgabe 6/2020

Einloggen, um Zugang zu erhalten

Zusammenfassung

Vorhofflimmern (VHF) stellt die häufigste Herzrhythmusstörung dar (2 % der Gesamtbevölkerung, 20 % bei über 80-Jährigen). Komplikationen des VHF sind der embolische Schlaganfall und die durch eine Tachyarrhythmie bedingte Herzinsuffizienz. Bis zu 50 % der Patienten, die eine herzchirurgische Therapie benötigen, haben anamnestisch ein VHF und können begleitend abladiert werden. Die 1991 durch Cox eingeführte traditionelle „Cut-and-sew“-Ablationstechnik stellt den „Goldstandard“ dar. Durch Verwendung alternativer Ablationstechnologien kann das operative Risiko reduzieret werden. Mögliche Ablationskonzepte sind die biatriale Maze-IV-Ablation, die erweiterte linksatriale Ablation oder die isolierte Pulmonalvenenisolation. Durch Ausschalten resp. elektrische Isolation des linken Vorhofohrs kann die Erfolgsrate der Ablation erhöht werden.
Literatur
1.
Zurück zum Zitat Gillinov AM, Gelijns AC, Parides MK, DeRose JJ Jr, Moskowitz AJ, Voisine P, Ailawadi G, Bouchard D, Smith PK, Mack MJ, Acker MA, Mullen JC, Rose EA, Chang HL, Puskas JD, Couderc JP, Gardner TJ, Varghese R, Horvath KA, Bolling SF, Michler RE, Geller NL, Ascheim DD, Miller MA, Bagiella E, Moquete EG, Williams P, Taddei-Peters WC, O’Gara PT, Blackstone EH, Argenziano M, CTSN Investigators. (2015) Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med 372:1399–1409CrossRef Gillinov AM, Gelijns AC, Parides MK, DeRose JJ Jr, Moskowitz AJ, Voisine P, Ailawadi G, Bouchard D, Smith PK, Mack MJ, Acker MA, Mullen JC, Rose EA, Chang HL, Puskas JD, Couderc JP, Gardner TJ, Varghese R, Horvath KA, Bolling SF, Michler RE, Geller NL, Ascheim DD, Miller MA, Bagiella E, Moquete EG, Williams P, Taddei-Peters WC, O’Gara PT, Blackstone EH, Argenziano M, CTSN Investigators. (2015) Surgical ablation of atrial fibrillation during mitral-valve surgery. N Engl J Med 372:1399–1409CrossRef
2.
Zurück zum Zitat Vinay Badhwar, J., Scott Rankin, Ralph J., Damiano, Jr, A. Marc Gillinov, Faisal G. Bakaeen, James R. Edgerton, Jonathan M. Philpott, Patrick M. McCarthy, Steven F. Bolling, Harold G. Roberts, Vinod H. Thourani, Rakesh M. Suri, Richard J. Shemin, Scott Firestone, Niv Ad, MD. (2017) The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 103:329–341. Vinay Badhwar, J., Scott Rankin, Ralph J., Damiano, Jr, A. Marc Gillinov, Faisal G. Bakaeen, James R. Edgerton, Jonathan M. Philpott, Patrick M. McCarthy, Steven F. Bolling, Harold G. Roberts, Vinod H. Thourani, Rakesh M. Suri, Richard J. Shemin, Scott Firestone, Niv Ad, MD. (2017) The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation. Ann Thorac Surg 103:329–341.
3.
Zurück zum Zitat Beckmann A, Meyer R, Lewandowski J, Markewitz A, Harringer W, German Heart Surgery Report 2018 (2019) The annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 67:331–344CrossRef Beckmann A, Meyer R, Lewandowski J, Markewitz A, Harringer W, German Heart Surgery Report 2018 (2019) The annual updated registry of the German Society for Thoracic and Cardiovascular Surgery. Thorac Cardiovasc Surg 67:331–344CrossRef
4.
Zurück zum Zitat Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau J, Lettino M, Lip G, Pinto F, Thomas GN, Valgimigli M, Van Gelder I, Van Putte BP, Watkins CL, ESC Scientific Document Group (2020) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). https://doi.org/10.1093/eurheartj/ehaa612CrossRef Hindricks G, Potpara T, Dagres N, Arbelo E, Bax JJ, Blomström-Lundqvist C, Boriani G, Castella M, Dan GA, Dilaveris PE, Fauchier L, Filippatos G, Kalman JM, La Meir M, Lane DA, Lebeau J, Lettino M, Lip G, Pinto F, Thomas GN, Valgimigli M, Van Gelder I, Van Putte BP, Watkins CL, ESC Scientific Document Group (2020) 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS). https://​doi.​org/​10.​1093/​eurheartj/​ehaa612CrossRef
6.
Zurück zum Zitat Henn MC, Lancaster TS, Miller JR, Sinn LA, Schuessler RAM, Melby SJ, Maniar HS, Damiano RJ (2015) Late outcomes after the Cox maze IV procedure for atrial fibrillation. J Thorac Cardiovasc Surg 5:1168–1176CrossRef Henn MC, Lancaster TS, Miller JR, Sinn LA, Schuessler RAM, Melby SJ, Maniar HS, Damiano RJ (2015) Late outcomes after the Cox maze IV procedure for atrial fibrillation. J Thorac Cardiovasc Surg 5:1168–1176CrossRef
7.
Zurück zum Zitat Cox JL, Schuessler RB, dÁgostino HJ Jr, Stone CM, Chang BC, Cain ME, Corr PB, Boineau PB (1991) The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 101:569–583CrossRef Cox JL, Schuessler RB, dÁgostino HJ Jr, Stone CM, Chang BC, Cain ME, Corr PB, Boineau PB (1991) The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. J Thorac Cardiovasc Surg 101:569–583CrossRef
8.
Zurück zum Zitat Weimar T, Schena S, Bailey MS, Maniar HS, Schuessler RB, Cox JL, Damiano RJ Jr (2012) The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades. Circ Arrhythm Electrophysiol 5:12–14CrossRef Weimar T, Schena S, Bailey MS, Maniar HS, Schuessler RB, Cox JL, Damiano RJ Jr (2012) The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades. Circ Arrhythm Electrophysiol 5:12–14CrossRef
9.
Zurück zum Zitat Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T (2018) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 20:e1–e160CrossRef Calkins H, Hindricks G, Cappato R, Kim YH, Saad EB, Aguinaga L, Akar JG, Badhwar V, Brugada J, Camm J, Chen PS, Chen SA, Chung MK, Nielsen JC, Curtis AB, Davies DW, Day JD, d’Avila A, de Groot NMSN, Di Biase L, Duytschaever M, Edgerton JR, Ellenbogen KA, Ellinor PT, Ernst S, Fenelon G, Gerstenfeld EP, Haines DE, Haissaguerre M, Helm RH, Hylek E, Jackman WM, Jalife J, Kalman JM, Kautzner J, Kottkamp H, Kuck KH, Kumagai K, Lee R, Lewalter T, Lindsay BD, Macle L, Mansour M, Marchlinski FE, Michaud GF, Nakagawa H, Natale A, Nattel S, Okumura K, Packer D, Pokushalov E, Reynolds MR, Sanders P, Scanavacca M, Schilling R, Tondo C, Tsao HM, Verma A, Wilber DJ, Yamane T (2018) 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation. Europace 20:e1–e160CrossRef
10.
Zurück zum Zitat Nishimura M, Lupercio-Lopez F, Jonathan C, Hsu JC (2019) Left atrial appendage electrical isolation as a target in atrial fibrillation. JACC Clin Electrophysiol 5:407–416CrossRef Nishimura M, Lupercio-Lopez F, Jonathan C, Hsu JC (2019) Left atrial appendage electrical isolation as a target in atrial fibrillation. JACC Clin Electrophysiol 5:407–416CrossRef
11.
Zurück zum Zitat Gutierrez EM, Castanoa M, Gualisa J, Martınez-Comendadorb JM, Maioranoa P, Castilloa L, Laguna G (2019) Beneficial effect of left atrial appendage closure during cardiac surgery: a meta-analysis of 280 585 patients. Eur J Cardiothorac Surg 2:252–262 Gutierrez EM, Castanoa M, Gualisa J, Martınez-Comendadorb JM, Maioranoa P, Castilloa L, Laguna G (2019) Beneficial effect of left atrial appendage closure during cardiac surgery: a meta-analysis of 280 585 patients. Eur J Cardiothorac Surg 2:252–262
12.
Zurück zum Zitat Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM (2018) Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. Ann Thorac Surg 103:329–341 Ad N, Holmes SD, Massimiano PS, Rongione AJ, Fornaresio LM (2018) Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation. Ann Thorac Surg 103:329–341
13.
Zurück zum Zitat Musharbash FN, Schill MR, Sinn LA, Schuessler RB, Maniar HS, Moon MR, Melby SJ, Damiano RJ (2017) Late results of the Cox-Maze IV procedure in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 153:1087–1094CrossRef Musharbash FN, Schill MR, Sinn LA, Schuessler RB, Maniar HS, Moon MR, Melby SJ, Damiano RJ (2017) Late results of the Cox-Maze IV procedure in patients undergoing coronary artery bypass grafting. J Thorac Cardiovasc Surg 153:1087–1094CrossRef
14.
Zurück zum Zitat Cox JL, Ad N, Palazzo T (1999) Impact of the maze procedure on the stroke rate in patients with atrial fibrillation. J Thorac Cardiovasc Surg 118:833–840CrossRef Cox JL, Ad N, Palazzo T (1999) Impact of the maze procedure on the stroke rate in patients with atrial fibrillation. J Thorac Cardiovasc Surg 118:833–840CrossRef
15.
Zurück zum Zitat Hanke T, Sievers HH, Doll N, Weimar T (2013) Surgical closure of the left atrial appendage in patients with atrial fibrillation. Indications, techniques and results. Herzschrittmacherther Elektrophysiol 24(1):53–57CrossRef Hanke T, Sievers HH, Doll N, Weimar T (2013) Surgical closure of the left atrial appendage in patients with atrial fibrillation. Indications, techniques and results. Herzschrittmacherther Elektrophysiol 24(1):53–57CrossRef
16.
Zurück zum Zitat Hanke T (2018) Surgical management of the left atrial appendage: a must or a myth? Eur J Cardiothorac Surg 53(suppl_1):i33–i38CrossRef Hanke T (2018) Surgical management of the left atrial appendage: a must or a myth? Eur J Cardiothorac Surg 53(suppl_1):i33–i38CrossRef
17.
Zurück zum Zitat Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL (2008) Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol 52:924–929CrossRef Kanderian AS, Gillinov AM, Pettersson GB, Blackstone E, Klein AL (2008) Success of surgical left atrial appendage closure: assessment by transesophageal echocardiography. J Am Coll Cardiol 52:924–929CrossRef
18.
Zurück zum Zitat Cullen MW, Stulak JM, Li Z, Powell BD, White RD, Ammash NM, Nkomo VT (2015) Left atrial appendage patency at cardioversion after surgical left atrial appendage intervention. Ann Thorac Surg 101:675–681CrossRef Cullen MW, Stulak JM, Li Z, Powell BD, White RD, Ammash NM, Nkomo VT (2015) Left atrial appendage patency at cardioversion after surgical left atrial appendage intervention. Ann Thorac Surg 101:675–681CrossRef
19.
Zurück zum Zitat Aryana A, Singh SK, Singh SM, O’Neill PG, Bowers MR, Allen SL, Lewandowski S, Vierra EC, Avila A (2015) Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization. Heart Rhythm 12:1431–1437CrossRef Aryana A, Singh SK, Singh SM, O’Neill PG, Bowers MR, Allen SL, Lewandowski S, Vierra EC, Avila A (2015) Association between incomplete surgical ligation of left atrial appendage and stroke and systemic embolization. Heart Rhythm 12:1431–1437CrossRef
20.
Zurück zum Zitat Meier B, Blaauw Y, Khattab AA, Lewalter T, Sievert H, Tondo C, Glikson M (2015) EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. EuroIntervention 10:1109–1125CrossRef Meier B, Blaauw Y, Khattab AA, Lewalter T, Sievert H, Tondo C, Glikson M (2015) EHRA/EAPCI expert consensus statement on catheter-based left atrial appendage occlusion. EuroIntervention 10:1109–1125CrossRef
21.
Zurück zum Zitat Ad N, Holmes SD, Lamont D, Shuman DJ (2017) Left-sided surgical ablation for patients with atrial fibrillation who are undergoing concomitant cardiac surgical procedures. Ann Thorac Surg 103:58–65CrossRef Ad N, Holmes SD, Lamont D, Shuman DJ (2017) Left-sided surgical ablation for patients with atrial fibrillation who are undergoing concomitant cardiac surgical procedures. Ann Thorac Surg 103:58–65CrossRef
22.
Zurück zum Zitat Voeller RK, Bailey MS, Zierer A, Lall SC, Sakamoto S, Aubuchon K, Lawton JS, Moazami N, Huddleston CB, Munfakh NA, Moon MR, Schuessler RB, Damiano RJ Jr. (2008) Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg 135:870–877CrossRef Voeller RK, Bailey MS, Zierer A, Lall SC, Sakamoto S, Aubuchon K, Lawton JS, Moazami N, Huddleston CB, Munfakh NA, Moon MR, Schuessler RB, Damiano RJ Jr. (2008) Isolating the entire posterior left atrium improves surgical outcomes after the Cox maze procedure. J Thorac Cardiovasc Surg 135:870–877CrossRef
23.
Zurück zum Zitat Weimar T, Gaynor SL, Seubert DY, Damiano RJ Jr, Doll N (2016) Performing the left atrial maze ablation pattern without atriotomy. Ann Thorac Surg 101:777–779CrossRef Weimar T, Gaynor SL, Seubert DY, Damiano RJ Jr, Doll N (2016) Performing the left atrial maze ablation pattern without atriotomy. Ann Thorac Surg 101:777–779CrossRef
24.
Zurück zum Zitat Tiwari KK, Gasbarri T, Bevilacqua S, Glauber M (2016) Right-Sided minithoracotomy as a Surgical Approach for the Concomitant Treatment of Atrial fibrillation. Res Cardiovasc Med 5:e31374CrossRef Tiwari KK, Gasbarri T, Bevilacqua S, Glauber M (2016) Right-Sided minithoracotomy as a Surgical Approach for the Concomitant Treatment of Atrial fibrillation. Res Cardiovasc Med 5:e31374CrossRef
25.
Zurück zum Zitat Tilz RR, Chun KR, Schmidt B, Fuernkranz A, Wissner E, Koester I, Baensch D, Boczor S, Koektuerk B, Metzner A, Zerm T, Ernst S, Antz M, Kuck KH, Ouyang F (2010) Catheter ablation of long-standing persistent atrial fibrillation: a lesson from circumferential pulmonary vein isolation. J Cardiovasc Electrophysiol 21:1085–1093CrossRef Tilz RR, Chun KR, Schmidt B, Fuernkranz A, Wissner E, Koester I, Baensch D, Boczor S, Koektuerk B, Metzner A, Zerm T, Ernst S, Antz M, Kuck KH, Ouyang F (2010) Catheter ablation of long-standing persistent atrial fibrillation: a lesson from circumferential pulmonary vein isolation. J Cardiovasc Electrophysiol 21:1085–1093CrossRef
26.
Zurück zum Zitat Ad N, Damiano RJ Jr, Badhwar V, Calkins H, La Meir M, Nitta T, Doll N, Holmes SD, Weinstein AA, Gillinov M (2017) Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. Ann Thorac Surg 103:329–341CrossRef Ad N, Damiano RJ Jr, Badhwar V, Calkins H, La Meir M, Nitta T, Doll N, Holmes SD, Weinstein AA, Gillinov M (2017) Expert consensus guidelines: Examining surgical ablation for atrial fibrillation. Ann Thorac Surg 103:329–341CrossRef
27.
Zurück zum Zitat January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW (2019) 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of patients with atrial fibrillation. Circulation 140:e125–e151CrossRef January CT, Wann LS, Calkins H, Chen LY, Cigarroa JE, Cleveland JC Jr, Ellinor PT, Ezekowitz MD, Field ME, Furie KL, Heidenreich PA, Murray KT, Shea JB, Tracy CM, Yancy CW (2019) 2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of patients with atrial fibrillation. Circulation 140:e125–e151CrossRef
Metadaten
Titel
Kombinierte chirurgische Therapie des Vorhofflimmerns
verfasst von
Prof. Dr. med. Thorsten Hanke
M. Lass
Publikationsdatum
13.11.2020
Verlag
Springer Medizin
Erschienen in
Zeitschrift für Herz-,Thorax- und Gefäßchirurgie / Ausgabe 6/2020
Print ISSN: 0930-9225
Elektronische ISSN: 1435-1277
DOI
https://doi.org/10.1007/s00398-020-00400-3

Weitere Artikel der Ausgabe 6/2020

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie 6/2020 Zur Ausgabe