4 years ago

Hybrid Surgical Versus Percutaneous Access Epicardial Ventricular Tachycardia Ablation

There is limited experience of surgical epicardial access in the contemporary era of ventricular tachycardia ablation after prior cardiac surgery. Objective To describe our institutional experience with surgical epicardial access, the influence of surgical approach and compare outcomes to a propensity-matched percutaneous epicardial access control group. Methods A retrospective study of consecutive surgical epicardial VT ablation cases from a single center was performed. Surgical cases were propensity-matched to percutaneous epicardial ablation controls and acute and long-term outcomes were compared. Results Between 2004-2016, 38 patients underwent 40 surgical epicardial access procedures (Subxiphoid n=22, Thoracotomy n=18). The indication was prior CABG(45%), valve surgery(22%) and VAD(10%). Procedure time was 444min (SD 107). Mapped epicardial geometry area was 149cm 2 (IQR 182) which comprised 36% of the mapped epicardial geometry area of a percutaneous control group. Subxiphoid access gave preferential access to the inferior/inferolateral LV segments and was less frequently able to access the anterior/anterolateral and apical segments compared to a thoracotomy approach. When compared to a propensity-matched percutaneous access group, acute outcomes, complication rates and 1-year survival free from a combined endpoint of VT recurrence, death or transplant were not statistically different. Conclusion Surgical epicardial access after cardiac surgery for ablation of VT in patients with careful pre-procedure evaluation can be performed with acceptable safety with no statistical difference in long-term outcomes compared to a propensity-matched percutaneous epicardial cohort. The region of LV epicardium that can be mapped is limited compared to percutaneous cases and is determined by the surgical approach.

Publisher URL: www.sciencedirect.com/science

DOI: S1547527117313231

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