A-fib Mini-Maze Surgery
Currently, St. Vincent’s is the only hospital in the state and among 10 healthcare organizations nationally providing the latest version of minimally invasive or “mini-maze” surgery to correct Atrial fibrillation or “A-fib,” a rapid or irregular heartbeat. Untreated A-fib is a primary cause of heart attack and stroke.
Surgical outcomes have been highly successful for this procedure at St. Vincent’s performed by Cardiothoracic Surgery Chief Rafael Squitieri, MD, and Minimally Invasive Cardiac Surgery Medical Director Albert DiMeo, MD.
Approximately 90% of people who undergo the procedure at St. Vincent’s do not experience another episode of A-fib, putting it among the highest in the nation. The surgery allows very fit people of all ages who had become debilitated by A-fib, to resume their often rigorous exercising and full schedule of family, career and recreational activities.
Candidates for mini-maze surgery
Min-maze surgery is currently recommended for patients who are in otherwise good physical condition, and in their 20s up to the early 70s, who want to get back to more strenuous activity. The surgery offers hope to patients for whom medication has not been effective or who cannot tolerate it, and for those who may not have been helped by earlier procedures.
The latest mini-maze surgery is totally thoracoscopic, or performed solely through endoscopes or flexible tubes inserted into two tiny, one-centimeter keyhole incisions on each side of the chest. A tiny camera and video-guided instruments are then inserted into the endoscopes to reach the heart and create a maze-like pattern of scarring or ablation with radio frequency energy which interrupts the electrical impulses that initiate A-fib.
Since this procedure is performed on a beating heart and does not require the large incisions in the sternum that characterize open-heart surgery, it can eliminate A-fib and irregular heartbeats without the long recovery associated with open heart surgery, which was the standard in the past. And tiny incisions mean less pain, smaller scars, shorter hospital stay and a quicker return to normal activity.
The surgery takes about three hours with a hospital stay of two to three days and follow-up rehabilitation.
Dramatically lessening stroke risk
Another benefit of the surgery is that the left atrial appendage, thought to be the location where stroke-causing blood clots form, is removed during the procedure, lessening stroke risk still further.
Advancements over earlier A-fib surgeries
The new technique is much less complex than the Cox “cut and sew” surgery, which requires the chest to be cut open, the ribs spread and the heart stopped before the electrical impulses could be blocked using surgical tools. In some cases, however, this open heart technique is performed if the patient has other heart problems to be corrected.
The latest surgery is also an advancement on the earlier mini-maze procedure, which also involved ablation to block the signals, but required the ribs to be spread, causing more blood loss, pain and a longer recovery.
In certain cases, other therapies such as trans-catheter ablation (TCA) or a combination of TCA and mini-maze surgery called Hybid Ablation may be indicated.
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