Surgeons at the Schulich Heart Centre have successfully performed one of the first “modified Maze” procedures, a unique new minimally invasive procedure to treat atrial fibrillation, a common heart rhythm disorder that may lead to stroke or heart failure.
Unlike traditional Maze procedures that create scar tissue through incisions, the modified Maze procedure involves the application of a controlled burn to problematic heart tissue that causes atrial fibrillation. The resulting scar tissue works to interrupt these abnormal conduction pathways, thus stabilizing the heart rhythm. This procedure has the potential to improve the patient’s quality of life by reducing the need for blood thinner or other medications. Patients may experience a faster recovery and shorter hospital stay.
“This new procedure adds another modality to the treatment of atrial fibrillation at Sunnybrook & Women’s,” says Dr. Gideon Cohen, staff cardiovascular surgeon at the Schulich Heart Centre and assistant professor of surgery at University of Toronto. “The real advantage is that now, we can achieve close to the same results as the Maze without the need for incisions and without stopping the heart. The procedure is simpler for the surgeon, and safer for the patient.”
Dr. Cohen first learned and applied the procedure during his Fellowship at the Cleveland Clinic, and is now one of only a few surgeons in Canada skilled to perform this procedure, which has had an approximate 85 per cent success rate in its first year of follow up in American cases. He works with electrophysiologist Dr. Eugene Crystal, who oversees the post-operative care of patients.
Dr. Cohen plans to train other cardiac surgeons at the Schulich Heart Centre in this new procedure. “As we become more experienced with this new technology, we hope to improve our results and achieve as close to a 100 per cent success rate as possible,” says Dr. Cohen. “Currently, we are only performing the modified Maze procedure on patients who are undergoing other procedures such as valve or bypass surgery, where the risks of using the traditional method are increased.” Eventually, the procedure may be performed on patients who suffer from only atrial fibrillation, and also as a preventative measure in patients with other conditions who may be at future risk of developing atrial fibrillation due to their underlying anatomy.
Multiple energy sources are currently available to create a controlled burn including cryo ablation (freezing), radio frequency ablation, laser ablation, and microwave ablation using microwave energy. “We chose microwave ablation since it easily lends itself to minimally invasive techniques, where the same procedure is performed using a scope through a small 5 cm incision, without the need for open heart surgery.” says Dr. Cohen.
The Schulich Heart Centre is the academic cardiovascular centre for Sunnybrook & Women’s offering a full spectrum of in-hospital and ambulatory cardiovascular care. In-hospital services include emergency cardiac care, diagnostic and interventional procedures, cardiac surgery, electrophysiology and cardiac rhythm management. The ambulatory cardiology practice includes hypertension, heart failure, and the Women’s Cardiovascular Health Initiative, a prevention and rehabilitation program.