Mid-term follow-up after maze IV procedures for concomitant atrial fibrillation.

BACKGROUND: We performed a retrospective analysis of the maze IV procedures performed in our surgical department for concomitant atrial fibrillation. METHODS: Preoperative, in-hospital and postoperative follow-up data were collected from 46 consecutive patients who underwent the maze IV operation between April 2006 and December 2010. All electrocardiograms and Holters were reviewed. RESULTS: One patient died in-hospital. During a mean follow-up of 25 +/- 16.3 months seven patients died: two related to a hemorrhagic stroke, one due to right ventricular failure, the remainder deaths were not cardiac related. The success rate, defined as no recurrence of AF or atrial flutter with a blanking period of 6 months postoperatively, was 73.7%. Plots of probability of freedom of atrial fibrillation over time are drawn and reach a stable level after one year. CONCLUSIONS: The mid term results of the maze IV procedures for concomitant atrial fibrillation are very good. The results are stable for the remainder of follow-up.

Laparoscopic repair of iatrogenic diaphragmatic hernias after sternectomy and pedicled omentoplasty.

PURPOSE: During sternectomy and pedicled omental flap transposition for the treatment of deep sternal wound infections, an ectopic diaphragmatic aperture is created. This may be the site of an iatrogenic diaphragmatic hernia, which may result in the herniation of intra-abdominal organs, and is difficult to repair. Although this complication was described as early as 1991, no effective treatment for this condition has been described previously. METHODS: The defect in poststernectomy diaphragmatic hernias has features similar to other incisional abdominal wall hernias, as well as to parastomal hernias and hiatal diaphragmatic hernias. We describe our laparoscopic approach developed from experience with these other types of hernias. We use an intraperitoneal flat mesh without keyhole. Fixation of the mesh to the anterior abdominal wall and to the diaphragm is done with a combination of sutures and spiral tackers. The omental pedicle is lateralised, fixed to the diaphragm and covered with the mesh. Special caution is needed when spiral tackers are applied to the diaphragm, because fatal complications of pericardial and cardiac injury have been described in laparoscopic hiatal diaphragmatic hernia repair. RESULTS: We used this technique in four patients who presented with a symptomatic poststernectomy diaphragmatic hernia. No procedure-related intra-operative or postoperative complications occurred. With a follow up of at least 12 months, no clinical or radiographic recurrence of diaphragmatic herniation has been encountered. CONCLUSION: We describe a laparoscopic technique to repair this difficult diaphragmatic hernia used in four patients, with a good clinical and computed tomographic outcome at 12 months.