小切開大動脈弁置換術と同時に行う心膜横洞経由の不整脈手術

Concomitant Arrhythmic Surgery during Minimally Invasive Aortic Valve Replacement

低侵襲心臓手術の技術的進歩はめざましく，近年では肋間小開胸による大動脈弁置換術（MICS-AVR）も一般的になってきた．また，フレキシブルシャフトの冷凍凝固デバイスの登場により，小切開での僧帽弁手術時に不整脈手術を同時施行することも増えてきている．一方で，MICS-AVRに併せて不整脈手術を行った報告は非常に少ない．本稿では，MICS-AVR時に心膜横洞経由で不整脈手術を行う方法を解説する．

Here we demonstrate concomitant arrhythmic surgery during minimally invasive aortic valve replacement via a right mini-thoracotomy. This procedure is performed through the transverse sinus；therefore, skin incision should be laterally shifted. After cardiac arrest, pulling up the ascending aorta offers fine exposure of the transverse sinus. The left atrial appendage is resected by a surgical stapling device. Then the ligament of Marshall is divided and the pericardial reflection at the left upper pulmonary vein is bluntly dissected. The articulating radiofrequency clamp is introduced into the oblique sinus under the aorta and the left pulmonary veins are electrically isolated. Finally, aortic valve replacement is performed in a standard manner.