Authors
Bystrov D.O.1, Komarov R.N.2, Shonbin A.N.1, Afonin B.O.1, Sorokin R.O.1, Matsuganov D.A.2
1 First City Clinical Hospital named after I.I. Volosevich, Russia, Arkhangelsk
2 I.M. Sechenov First Moscow State Medical University, Moscow
Abstract
Objective. To perform a meta-analysis of publications to assess the safety and effectiveness of epicardial thoracoscopic ablation.
Material and methods. The research was searched for and selected by two independent researchers. Any disagreements were resolved by involving a third party. When summarizing the data from individual studies, taking into account the significant statistical heterogeneity of the indicators, a random effects model was used.
Results. In total, 13 articles are included in the analysis. The number of patients presented in the publications ranged from 10 to 475, with an average age of 54 to 62 years. A meta-analysis of the development of all complications; major cardiac and cerebral complications; freedom from atrial fibrillation after 12 months was performed. The analysis of the number of complications by different authors revealed that the average frequency of the complicated postoperative period was 11.0% (95% CI 1.0–1.5%). The indicator had high heterogeneity (I2 = 85.5%, p<0.001), taking values from 1.0% (van Laar, 2019) to 39.0% (Adiyaman, 2018). A meta-analysis of the incidence of major cardiac and cerebral complications showed that the average result was 2%. The indicator had moderate heterogeneity (I2 = 35.5%, p = 0.01). The results of a meta-analysis of the frequency of freedom from atrial fibrillation 12 months after epicardial thoracoscopic ablation surgery showed that, on average, the sinus rhythm was maintained in 79% of patients (95% CI 73.0–85%). The indicator had high heterogeneity (I2 = 87.4%, p<0.001), taking values from 35.0% (Adiyaman, 2018) to 95.0% (Sindby, 2018). Conclusion. This study showed the high effectiveness of the operation under study for the treatment of atrial fibrillation with a low risk of major cardiac and cerebral complications.
Keywords: аtrial fibrillation, maze, thoracoscopic epicardial ablation, minimally invasive cardiac surgery.
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