Mini-Maze Surgical Ablation (Closed Chest)
Not everyone with atrial fibrillation needs to have open heart surgery. In fact, about one-third of afib patients don't have any other heart issues. For most, the open chest procedure just doesn't make sense, especially with its long and difficult recovery period.
Fortunately, if you have afib only (lone afib), there is a minimally-invasive version of Maze surgical ablation. It's called Mini-Maze surgery, evolved from the Cox-Maze III "cut-and-sew" procedure, and is performed on a beating heart without opening your chest.
To get to the heart, the surgeon makes three small incisions on each side of the chest, and through these incisions places surgical instruments, an ablation device, and an endoscope. With the endoscope, a camera and direct vision device, the surgeon can see the heart inside the chest.
A surgical ablation energy source is used to create a conduction block that isolates the pulmonary veins and stops the chaotic electrical signals from disrupting the heart. While in there, the surgeon removes the left atrial appendage to reduce the risk of blood clots and stroke.
This surgery takes only a few hours, and doesn't require the large incisions in the sternum that are necessary for open-heart surgery. Thus, recovery time is much shorter and easier, and most patients are afib-free afterwards. Mini-Maze surgery offers a potential cure for atrial fibrillation and irregular heartbeats without the difficulty and long recovery time of open-heart surgery.
While patients with paroxysmal afib have been considered the best candidates for Mini-Maze surgery, recent results have shown great success with persistent and permanent afib as well.
Mini-Maze Surgical Ablation (Closed Chest)
Image courtesy of AtriCure, Inc.
While the FDA has only approved medication for treating atrial fibrillation, surgical approaches are currently undergoing clinical trials to establish their effectiveness in treating and curing afib. If medicine isn't managing and controlling your afib, you may wish to discuss surgical approaches with your doctor. For more information, see Partnering With Your Doctor.
If you're considering Mini-Maze surgery, you need to know about the success rates and the risks.
Mini-Maze Surgical Ablation Risks
Any procedure dealing with the heart has risks. Typical Mini-Maze surgery risks include: 1
- Collapsed lung from deflating the lung in surgery, which is correctable with a chest tube
- Vein inflammation (Phlebitis)
- Heart tissue inflammation (Pericarditis)
- Blood vessel damage
- Heart damage
Some of the common risks of catheter ablations, such as blood clots and strokes, aren't found in Mini-Maze surgery. That's because no catheters are involved. And since the surgeon uses an endoscope to see the heart, the risk of obstruction of the pulmonary veins (pulmonary vein stenosis) that is seen in catheter ablations is nearly eliminated in Mini-Maze.
Mini-Maze Surgical Ablation Success Rates
Mini-Maze surgery is so new that a large body of results doesn't yet exist, but clinical trials are underway. However, the high success rates seen in open chest Maze surgical ablation appear to translate to Mini-Maze surgery as well.
There was an early Mini-Maze surgical ablation study that was published in 2005 with results from the University of Cincinnati. The study showed that 91.3% of patients who had Mini-Maze surgery using a bipolar radiofrequency ablation system (AtriCure) and removal of the left atrial appendage were afib-free after 6 months, with only 25% requiring anti-arrhythmic drugs. 2
If you want to know if you are a candidate for Mini-Maze surgery, see Are You a Candidate for Mini-Maze Surgery?
1 Surgical Ablation for Atrial Fibrillation" <http://www.afibfacts.com/Treatment_Options
_for_Atrial_Fibrillation/Surgical_Ablation_for_Atrial_Fibrillation/>, AfibFacts.com [Internet], Copyright, 2007.
2 Wolf, Randall K., et al, "Video-assisted bilateral pulmonary vein isolation and left atrial appendage exclusion for atrial fibrillation" <http://jtcs.ctsnetjournals.org/cgi/content/abstract/130/3/797>, Journal of Thoracic and Cardiovascular Surgery, 2005;130:797-802.
