Radial approach: A new concept in surgical treatment for atrial fibrillation I. Concept, anatomic and physiologic bases and development of a procedure

作     者：Nitta, T Lee, R Schuessler, RB Boineau, JP Cox, JL 

作者机构：Washington Univ Sch Med Div Cardiothorac Surg St Louis MO 63110 USA Washington Univ Sch Med Div Cardiol St Louis MO 63110 USA 

出 版 物：《ANNALS OF THORACIC SURGERY》 (胸外科学纪事)

年 卷 期：1999年第67卷第1期

页      面：27-35页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

基　　金：NHLBI NIH HHS [5 RO1 HL32257  5 T32 HL007776  5 RO1 HL33722] Funding Source: Medline 

主　　题：心房颤动/病理生理学 心房颤动/外科学 心房功能 心脏外科手术/方法 心房/神经支配 心脏传导系统/病理生理学 动物 狗 女(雌)性 人类 男(雄)性 

摘      要：Background. The maze procedure cures atrial fibrillation;however, it isolates the pulmonary vein area and results in discordant activation in certain adjacent left atrial segments, which affects left atrial function. To preserve a more physiologic atrial transport function, we developed a new concept of surgical treatment for atrial fibrillation-the radial approach. The atrial incisions radiate from the sinus node toward the atrioventricular annular margins to allow a more physiologic atrial activation sequence and parallel the atrial coronary arteries to preserve blood supply to most atrial segments. Methods. We examined the atrial coronary arteries and the activation sequence during sinus rhythm in normal canine hearts to design the atrial incisions according to the concept of a radial approach. Results. The pattern of coronary artery distribution was centripetal, branching from the right coronary or left circumflex coronary artery at the right or left atrioventricular groove and spreading toward the sinus node. The endocardial mapping of the atria disclosed some important findings in designing the atrial incisions of the radial approach: the activation sequence at the left atrial septum and at the posterior left atrium between the pulmonary vein orifices. The atrial incisions were designed according to these findings. Conclusions. The radial approach may represent a more physiologic atrial transport function. (C) 1999 by The Society of Thoracic Surgeons.