Total Thoracoscopic Maze Procedure
The Ohio State University Medical Center is one of only four centers in the United States performing the most minimally invasive of surgeries to treat and effectively cure atrial fibrillation. This surgery is called a Total Thoracoscopic MAZE procedure. It is a closed chest, beating heart procedure and is performed without the use of the heart-lung bypass machine. The totally thoracoscopic approach offers patients a quick recovery and minimal discomfort after surgery. This procedure has shown to be 90% effective after one year in maintaining sinus rhythm without the use of any anti-arrhythmic medications in patients with all types of atrial fibrillation. 15
How the surgery is done Three or four small incisions are made on each side of the chest. Each incision is about ¼ inch, or 1 centimeter long. A fiber optic camera and special tools are used to perform the entire procedure through these tiny incisions. The surgery is done without a large chest incision, without the heart-lung machine, and without stopping the heart.
During the surgery, the doctor uses real-time mapping techniques to find the sources of atrial fibrillation in each patient’s heart. This means that the doctor uses special technology during the surgery to identify, or map, the areas of the heart where the abnormal electrical signals originate. There are also nerve areas on the heart that can trigger the abnormal electrical impulses.12 13 All identified trigger areas, both nerve areas and mapped areas, are identified during the surgery, and safely treated. The nerve areas are not accessible during a catheter ablation, which is why the Total Thoracoscopic MAZE procedure is more effective. Because these areas are mapped for each patient and it is done from the outside of the heart, there is no damage to the muscle or lining on the inside of the heart. A recent study of 41 patients that had a minimally invasive maze procedure to treat atrial fibrillation showed that several nerve areas tested positive as possible triggers for the AF in all 41 patients.11
Each area that is identified and treated is then tested to ensure there is no conduction of electrical impulses across the treated tissue. This allows the doctors to ensure the treatments have been effective while the patient is still in the operating room. The procedure also involves removing a small area of the left atrium, called the left atrial appendage, where most blood clots form. This reduces the risk of stroke in patients with atrial fibrillation. The entire operation takes between 2-4 hours patients only spend one to two nights in the hospital and have minimal discomfort.15
After Surgery Once the patient is discharged home, he/she can expect:
· Most patients remain in normal rhythm without rhythm-control medication. A small portion of patients with chronic atrial fibrillation may have relapses in the early post-operative period. This is due to inflammation from the operation itself that causes some temporary irritability in the heart’s electrical system. The inflammation is gone in 3-4 weeks, leaving nearly all patients in normal sinus rhythm. · Blood-thinning medicine is continued in all patients for three months after surgery. It is then stopped in patients who remain in normal rhythm. · Rhythm-control medications are stopped after surgery. For the small amount of patients who have atrial fibrillation after surgery, rhythm-control medications are used for 3-4 weeks until the heart heals and the inflammation affecting the heart’s electrical system in gone. · All patients will need to wear a pager-sized heart rhythm monitor at 3, 6, and 12 months after surgery. This allows the doctor to know how well the heart rhythm is controlled after surgery. It will determine if it is safe to stop any of your medications, including rhythm-control or blood-thinning medications, and if you have been effectively cured from the disease.
For more information, please contact Dr. John Sirak . You may e-mail him at john.sirak@osumc.edu, or call (614) 293-5502.
12 Marjan, J, Graeme, W, Mandal, K, et al. Current Strategies in the Management of Atrial Fibrillation. Annals of Thoracic Surgery 2006; 82: 357-364. 13 Ha?ssaguerre, M, Ja?s, P, Shah, D, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. New England Journal of Medicine 1998; 339: 659-666. |