Typical incisions associated with the Mini-Maze procedure.
See true life photo example below.
The risk of stroke in patients with AF is estimated at 7 times greater than patients without AF. AFis second only to heart failure in terms of cardiac related hospitalizations. The procedure and technology are designed to treat AF in patients who are non-responsive or suffer from disabling side effects of drug therapy. These were the first patients treated in the US using AtriCures technology without open heart surgery, and with the removal of the left atrial appendage, a small, but unneeded part of the heart, where blood clots tend to form.
The ISOLATOR clamp, which generates bipolar radio frequency, is used to isolate specific cardiac structures responsible for AF. The isolation procedure is performed using minimally invasive video assisted instruments.
Additional devices used include the CoolRail and Bipolar Pen which are instrumental in being able to complete the Cox Maze lesion set demonstrated to achieve correction of Afib to Normal Sinus Rhythm. The instruments are inserted into the chest through two small incisions, one on each side of the chest. The ISOLATOR clamp,CoolRail and Bipolar Pen, use radio frequency energy to isolate a precise area of the heart tissue and interrupt the abnormal circuits that cause the irregular heartbeat similar to the way a berm or levy blocks the passage of a river.
The parasympathetic innervation of the heart is also targeted by high frequency stimulation of the vagal ganglionic plexi which allows for their mapping and subsequent disruption during the procedure.
In addition, the left atrial appendage, the responsible source of over 90% of cardioembolic strokes AF patients, is also removed. The traditional Maze procedure has been used world-wide to treat AF, but until now its use has been primarily for patients with AF who were undergoing major open heart surgery for other cardiac diseases.
The new less invasive Mini-Maze procedure allows patients who have suffered from long-standing on-again, off again or chronic AF to undergo a less invasive surgery to cure their AF and recover faster than traditional surgery for AF. Two significant advances have recently been developed to achieve even better results with less invasiveness.
A "hybrid" strategy utilizing surgical ablation of the left atrium and catheter ablation of the right atrium has resulted in improved outcomes, particularly in patients with longer term Atrial Fibrillation. Additionally, a totally thoracoscopic (TT) approach has enabled patients to be operated on with even less trauma to the chest wall resulting in less postoperative pain.
Patients who undergo this procedure have hospital stays of two to three days, compared to seven or more with conventional surgery. Approximately 600 patients have undergone this procedure worldwide with over 95% success in curing atrial fibrillation in patients with Paroxysmal AF and approximately 90% success in those with chronic AF. Medicare, Medicaid and private insurers cover the procedure.
Example of Incisions and Cosmesis
Totally Thoracoscopic (TT) Approach is even less invasive.
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