# Concomitant Convergent Ablation, Left Atrial Appendage Closure, and Minimally Invasive Direct Coronary Artery Bypass: A Case Series

## TL;DR

This paper reports a new surgical approach combining three procedures in one operation, showing it is safe and feasible.

## Contribution

The first report of combining convergent ablation, LAA closure, and MIDCAB in a single operation.

## Key findings

- Three patients underwent combined procedures with no intra- or postoperative events.
- At one-year follow-up, no serious adverse events occurred.
- One patient had a relapse of atrial fibrillation, but graft function was preserved.

## Abstract

We present the first report of concomitant convergent ablation, left atrial appendage (LAA) closure, and minimally invasive direct coronary artery bypass (MIDCAB) procedures during a single operation. Three patients had coronary artery disease of the left anterior descending artery and atrial fibrillation. All were offered concomitant convergent ablation and LAA closure during the MIDCAB procedure. There were no intra- or postoperative events. At one-year follow-up, no serious adverse events had occurred. One patient had experienced a relapse of paroxysmal atrial fibrillation, and one patient, with a well-functioning graft, had been medically optimized for angina. Our report shows that combining convergent ablation, LAA closure, and MIDCAB can be done feasibly and safely, enabling efficient minimally invasive approaches to future complex cases.