ABSTRACT 89

"PUMP-OFF" SURGICAL TREATMENT OF TACHYARRHYTHMIAS

Jurgis Bredikis and Audrius Bredikis, Department of Cardiac Surgery, Kaunas Medical University, Lithuania and Department of Cardiology, Loyola University, Chicago

Our experimental and technical investigations led to development of “off-pump” surgical technique for ablation of cardiac arrhythmias in the beating heart.  Cryoablation with liquid nitrogen produces temperatures <-100 C and does not require CPB and/or cardioplegia to achieve transmural lesion formation.  In 1977 first closed-heart intracardiac cryoablation of his bundle was performed, later different approaches and technique for epicardial cryogenic and laser ablation and intracardiac cryoablation were developed and successfully applied in 1165 pts. "Off-pump" ablation was performed in pts. with:  WPW syndrome, AVNRT, RVOT, atrial fibrillation and few cases of LV and VT.  The “off-pump” closed-heart ablation in contrast to surgery using CPB and especially cold cardioplegia, does not alter electrophysiological features of arrhythmogenic substrate, hence making possible not only pre-ablation mapping but the immediate re-mapping and control of ablation efficacy.  Ablation on the beating heart offers other important advantages:  decreased traumaticity and morbidity, length of hospitalization and procedural costs.  Principles and developed procedures for cryoablation of arrhythmias in the beating heart in 80’s can serve as basis for arrhythmia ablation via minimally invasive or robotically assisted cardiac surgery in the new millennium.