Surgical treatment of Wolff-Parkinson-White syndrome without cardiopulmonary bypass

From October 1989, 88 patients underwent surgical interruption of atrio-ventricular by-pass tracts for the treatment of Wolff-Parkinson-White syndrome without the aid of cardiopulmonary bypass. Patients (56 males, 32 females, mean age 35.5 yrs, range 11-56) were addressed to surgery because of a story of syncope, atrial fibrillation, cardiac arrest, young age, refractoryness to multiple drugs treatment, or EP evidence of fast conduction along the accessory pathway. At operation, all patients underwent manual and/or automatic atrial and ventricular mapping under tachycardia and/or pacing: accessory pathways was located on the right free wall in 13 patients, on the left in 47, in the postero-septal region in 25 patients and in the antero-septal in 12 (11 double pathways). Four patients had associated AVN reentry tachycardia and one had respectively ectopic atrial tachycardia, idiopatic paroxysmal atrial fibrillation, Coumel tachycardia, chronic atrial fibrillation secondary to mitral valve stenosis. Epicardial dissection through the AV fat pad down to the corresponding sector of the cardiac skeleton was performed and cryoblations were performed along the dissected sector. Careful heart dislodgement was necessary to expose the postero-septal region and the left free wall sector, and avoidance of CPB was easily achieved in all but one patient. Cardiopulmonary bypass was required for discrete cryoablation around the AV node (4 pts), aortic valve replacement, mitral valve replacement plus left atrial isolation, 'Corridor' procedure, mitral valve repair, ASD closure, mixoma resection (1 pt respectively). Ablation was effective in all but one patient, where non-decremental conduction was found at EPS. All other patients are free from arrhythmia and without medications 1 to 24 months from operation.