{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,30]],"date-time":"2026-09-30T12:20:03Z","timestamp":1790770803227,"version":"4.1.0"},"reference-count":22,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T00:00:00Z","timestamp":1660089600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2022,10,4]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p\/>\n               <jats:sec>\n                  <jats:title>OBJECTIVES<\/jats:title>\n                  <jats:p>Thoracoscopic ablation for atrial fibrillation (AF) and minimally invasive direct coronary artery bypass (MIDCAB) with robot-assisted left internal mammary artery (LIMA) harvesting may represent a safe and effective alternative to more invasive surgical approaches via sternotomy. The aim of our study was to describe the feasibility, safety and efficacy of a unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB surgery.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>Retrospective analysis of a prospectively gathered cohort was performed of all consecutive patients with AF and at least a critical left anterior descending artery (LAD) stenosis that underwent unilateral left-sided thoracoscopic AF ablation and concomitant off-pump MIDCAB surgery in the Maastricht University Medical Centre between 2017 and 2021.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>Twenty-three patients were included [age 69\u2009years (standard deviation\u2009=\u20098), paroxysmal AF 61%, left atrial volume index 42\u2009ml\/m2 (standard deviation\u2009=\u200911)]. Unilateral left-sided thoracoscopic isolation of the left (n\u2009=\u200923) and right (n\u2009=\u200922) pulmonary veins and box (n\u2009=\u200921) by radiofrequency ablation was succeeded by epicardial validation of exit- and entrance block (n\u2009=\u200922). All patients received robot-assisted LIMA harvesting and off-pump LIMA-LAD anastomosis through a left mini-thoracotomy. The perioperative complications consisted of one bleeding of the thoracotomy wound and one aborted myocardial infarction not requiring intervention. The mean duration of hospital stay was 6\u2009days (standard deviation\u2009=\u20092). After discharge, cardiac hospital readmission occurred in 4 patients (AF n\u2009=\u20091; pleural- and pericardial effusion n\u2009=\u20092, myocardial infarction requiring the percutaneous intervention of the LIMA-LAD n\u2009=\u20091) within 1 year. After 12\u2009months, 17\/21 (81%) patients were in sinus rhythm when allowing anti-arrhythmic drugs. Finally, the left atrial ejection fraction improved postoperatively [26% (standard deviation\u2009=\u200911) to 38% (standard deviation\u2009=\u20097), P\u2009=\u20090.01].<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>In this initial feasibility and early safety study, unilateral left-sided thoracoscopic AF ablation and concomitant MIDCAB for LIMA-LAD grafting is a feasible, safe and efficacious for patients with AF and a critical LAD stenosis.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ejcts\/ezac409","type":"journal-article","created":{"date-parts":[[2022,8,10]],"date-time":"2022-08-10T17:54:01Z","timestamp":1660154041000},"source":"Crossref","is-referenced-by-count":9,"title":["Unilateral left-sided thoracoscopic ablation of atrial fibrillation concomitant to minimally invasive bypass grafting of the left anterior descending artery"],"prefix":"10.1093","volume":"62","author":[{"given":"Claudia A J","family":"van der Heijden","sequence":"first","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7414-3712","authenticated-orcid":false,"given":"Patrique","family":"Segers","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna","family":"Masud","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vanessa","family":"Webernd\u00f6rfer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sevasti-Marisevi","family":"Chaldoupi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , Maastricht, Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin G L M","family":"Luermans","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , Maastricht, Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geertruida P","family":"Bijvoet","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre , Maastricht, Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas L J H","family":"Kietselaer","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"},{"name":"Department of Cardiology, Zuyderland Medical Center , Heerlen, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sander M J","family":"van Kuijk","sequence":"additional","affiliation":[{"name":"Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center , Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul J C","family":"Barenbrug","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3230-7712","authenticated-orcid":false,"given":"Jos G","family":"Maessen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elham","family":"Bidar","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8622-1450","authenticated-orcid":false,"given":"Bart","family":"Maesen","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery, Maastricht University Medical Centre , Maastricht, Netherlands"},{"name":"Cardiovascular Research Institute Maastricht, Maastricht University , Maastricht, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,8,10]]},"reference":[{"key":"2022100712481772600_ezac409-B1","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS) The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) Developed 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