Criocoagulación de venas pulmonares como tratamiento complementario de la fibrilación auricular en cirugía valvular

background: the cox maze iii operation for the treatment of atrial fibrillation (af) is complex and consumes significant operative time. cryoablation of the pulmonary veins (cpv) is a simpler alternative for patients that require concomitant valvular surgery. aim: to evaluate cpv in patients with af submitted to valvular surgery. patients and methods: twenty one patients had simultaneous valvular surgery and cpv, 81 % of them had permanent affor an average of 5 years. twenty patients had mitral valve disease. the etiology was rheumatic in 14. average left atrial diameter was 60 mm. in 7patients the mitral valve was replaced, in 5 it was repaired, in 7 both mitral and aortic valve were replaced, in 1 the mitral valve was repaired and the aortic valve was replaced and in 1 only the aortic valve was replaced. a combined transeptal and superior approach was used for all patients. the cpv was performed after the valvular procedure with cryothermy at -60°c for 2 minutes with two 15 mm cryoprobes applied simultaneously. results: cpv increased surgical time by 10 to 20 minutes. operative mortality was 4.8% (1 patient). one patient developed a pericardial effusion and another a complete heart block that required a permanent pacemaker. all patients improved their functional class. at the end of an average 10.5 months of follow-up, 50% of patients were in normal sinus rhythm and 25% persisted in af. the remaining patients were in some type of regular rhythm. conclusions: cpv as a complementary procedure in patients with af undergoing valvular surgery had good results to abate af. it restored normal sinus rhythm in 50% of the cases, with low morbidity and mortality and little increment in surgical time