Robotic Biatrial Maze with Thoracoscopic Left Atrial Appendage Clip

K. E.. Hodges¹, P. M.. McCarthy², J. L.. Cox^3
1Northwestern Memorial Hospital, Chicago, Illinois ²Northwestern Medicine, Division of Cardiac Surgery, Chicago, Illinois ³Northwestern University, Chicago, Illinois

Please explain the educational or technical point that this video addresses.: Minimally invasive surgical ablation for atrial fibrillation and left atrial appendage occlusion is an evolving practice area. This video demonstrates a technique for a complete biatrial cryomaze using robotic assistance. Concomitant left atrial appendage occlusion with a commercially available clip through a left video assisted thoracoscopic (VATS) approach provides reproducible, effective left atrial appendage closure.

Please provide a 250 word summary of the surgical video being submitted.: This video demonstrates the surgical technique for a complete biatrial cryomaze using robotic assistance with concomitant eft atrial appendage occlusion with a commercially available clip. The operation begins with a left video assisted thoracoscopic (VATS) approach to the left atrial appendage (LAA). Intraoperative transesophageal echocardiography (TEE) confirms the absence of preoperative LAA thrombus and that the LAA has been completely obliterated following clip application. The operation continues with a right-sided robotic approach for a complete biatrial cryomaze. Left atrial lesions, including an epicardial coronary sinus lesion, box around the pulmonary veins with extension to the base of the LAA, and mitral anulus lesion are performed with three-minute applications of the cryo probe. Right atrial lesions, including tricuspid anulus, superior vena cave (SVC), inferior vena cave (IVC), and right atrial appendage lesions are performed for two minutes. The video concludes with a brief discussion of our institutional protocol for follow-up and management of antiarrhythmic therapy and anticoagulation following a maze procedure.