New Heart Procedure Involves Less Scarring, Quicker Recovery

There’s new hope for the hundreds of thousands of Americans with intermittent atrial fibrillation: the “mini-Maze,” a minimally invasive version of the Cox-Maze procedure that involves scarring the heart to allow electrical impulses sent by the brain to travel correctly.

Richard Lee, M.D., a SLUCare cardiac surgeon, recently became the first surgeon in the state of Missouri and one of only a handful in the country to perform the mini-Maze, which is for patients with non-continuous atrial fibrillation, a condition that occurs when the upper and lower chambers of the heart begin beating at mismatched rhythms. Left untreated, it increases the risk of stroke and can lead to long-term heart failure. Lee says he has been intrigued by the mini-Maze since it was developed at the University of Cincinnati, but he wanted to wait until there was conclusive evidence it was a safe procedure before training to learn it. “Before I put my own patients at risk, I wanted to make sure this surgery was as good as it had been purported, and there are now studies that show it has a 90 percent success rate at curing atrial fibrillation,” Lee says. “Patient safety is my number one priority, and I believe the mini-Maze has tremendous potential to make people’s lives better.” Using micro-miniature television cameras, surgeons reach the heart by creating two, two-inch incisions – much smaller than the seven inches required for the conventional Maze procedure – between the patient’s ribs, one on each side of the chest. With the help of a radio frequency clamp, surgeons ablate – or destroy tissue by burning it – and electrically isolate the pulmonary veins, where the triggers that activate atrial fibrillation are located. Unlike its predecessor, the mini-Maze doesn’t require a patient’s breastbone to be broken, and patients only need to take blood-thinning medication for about six weeks. Additionally, the mini-Maze is a safer, more effective option than catheter-based pulmonary vein ablative approaches, Lee says. “One of the major problems for patients with atrial fibrillation is that they need to be on blood thinners for the rest of their lives. Patients who take them are at risk for excessive bleeding or embolism (stroke) at a rate of 1 to 2 percent every year that they take them. But the rate of stroke is even higher than that if they don’t take them.” According to the American Heart Association, atrial fibrillation is a disorder found in about 2.2 million Americans. In it the heart’s two small upper chambers (the atria) quiver instead of beating effectively. Blood isn’t pumped completely out of them, so it may pool and clot. If a piece of a blood clot in the atria leaves the heart and becomes lodged in an artery in the brain, a stroke results. About 15 percent of strokes occur in people with atrial fibrillation. The likelihood of developing atrial fibrillation increases with age. Three to five percent of people over 65 have atrial fibrillation. (Source: Saint Louis University School of Medicine: February 2006.)