Minimally Invasive Mini-Maze Surgery Has Potential to Eliminate Atrial Fibrillation and Reduce Risk of Stroke
The Mini-Maze is a revolutionary new type of surgery that can correct atrial fibrillation (AF), a common form of heart rhythm abnormality and a major cause of stroke. The procedure, called The Mini-Maze, offers new hope to AF patients for whom no reasonable cure now exists.
Using Bipolar Radiofrequency, the Pulmonary Veins are able to be electrically isolated. Communicating lesions are drawn over the dome of the left atrium and to the mitral annulus. A lesion is also created from the base of the left atrial appendage to the left pulmonary vein lesion. In addition, the vagal ganglionic plexi are mapped and ablated, as well, thus neutralizing the parts of the heart responsible for causing and sustaining AF. The ligament of Marshall is divided as well. The procedure has enabled the restoration of normal sinus rhythm, which in conjunction with the removal of the left atrial appendage, another key aspect of the procedure, the risk of stroke for the patient is virtually eliminated. Performed via a minimally invasive approach, the procedure is well tolerated and most patients return quickly to full activity. Hospital stay is typically 3 days.
A subsequent right sided lesion is made several weeks later by an electrophysiologist in the EP lab as an outpatient. This hybrid approach improves the long term durability of the procedure and increases the success rate in achieving normal sinus rhythm.
Novel Procedure with Traditional Techniques
The Mini-Maze procedure involves the use of thoracoscopy, whereby a video telescope is inserted into the chest and instruments specially designed for the procedure are inserted via small ports or key hole incisions. Surgeons are able to burn lines in the heart, isolating areas where the irregular signal starts. The damaged tissue can no longer conduct electrical impulses, interrupting the transmission of the abnormal signal and allowing the rest of the chamber to resume beating normally. Commonly a lesion set is placed on the right side of the atrium by the electrophysiologist in the EP lab. Access to the right atrial structures involved with AF is easier for the electrophysiologist than the surgeon whereas access to the left sided structures is simpler for the surgeon. This combination of techniques allows for a more extensive lesion set to be developed which, for the patient with persistent or permanent AF, most closely approaches the classic Cox Maze lesion set and thus yields the greatest results for cure.
In addition the left atrial appendage, a fingerlike structure where clots form, is removed. This significantly reduces the stroke risk faced by patients on a daily basis. Experience to date indicates that Mini-Maze surgery eliminates AF in more than 90% of patients who undergo the procedure.
Procedure Improves Treatment Options
AF is now most often treated with anticoagulant drugs, which do nothing to address the abnormal heart beat but instead are used to prevent the formation of blood clots. These clots, which form when blood stagnates and pools in the poorly functioning atria, account for the high risk of stroke in patients with AF. Lifelong anticoagulant therapy is necessary, but these drugs increase the risk of bleeding and require frequent blood tests to ensure that the level of medication is the right range. In addition, medications used to treat AF and regulate both heart rate and control rhythm have significant side effects as well as toxicities, which may be poorly tolerated.
Statement by Dr. Steinberg
"With the Mini-Maze procedure, we finally have a dramatic new ability to improve the quality of patients lives for whom there previously were few good options."
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