Healing the heart without opening the chest:

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There is a new, less invasive surgical option for correcting an irregular heartbeat that does not respond to conventional treatment, and the Schulich Heart Centre at Sunnybrook Health Sciences Centre is the only place in the country to offer it. Not only does it allow a shorter hospital stay and quicker recovery, but recent evidence suggests that its success rate is very close to traditional open-heart surgery.

Dr. Gideon Cohen, a cardiovascular surgeon at Sunnybrook, was the first to perform the procedure in Canada in 2004. It is designed to treat a condition called atrial fibrillation, a common type of heart rhythm disorder associated with an increased risk of stroke and heart failure. While some patients find relief with standard treatment options such as medication, lifestyle changes or pacemakers, others are left with no option but surgery.

The leading-edge minimally invasive surgery is a variation on the “Maze” procedure. The traditional Maze involves opening the chest cavity, stopping the heart using a heart-lung machine and creating a “maze” of controlled incisions in the heart. In the modified Maze, instead of using a scalpel the surgeon uses freezing, radiofrequency waves, lasers or microwaves to generate controlled burns in the heart. In both cases, scar tissue forms and blocks the electrical circuits responsible for producing an abnormal heart rhythm. While the traditional Maze is still considered the gold standard surgical treatment for atrial fibrillation, it is only performed on patients undergoing other open-chest procedures such as bypass surgery.

For more than three years now, Dr. Cohen has been performing the thoracoscopic modified Maze in a minimally invasive way as a stand-alone procedure. There is no opening of the chest of stopping of the heart. Rather, he makes three small incisions on each side of the patient’s chest to insert a tiny camera and specialized surgical instruments capable of generating microwaves.

Approximately 25 patients have undergone minimally invasive Maze surgery at Sunnybrook since 2004, and the success rate to date is about 80 per cent, compared to 90 per cent for the open-chest maze. Patients are obviously attracted to the less invasive nature of the procedure, and Dr. Cohen receives referrals from all across North America. Yet he cautions that not everyone is a candidate for the procedure. For example, those with paroxysmal atrial fibrillation – an irregular heart rhythm that comes and goes – are better suited to the minimally invasive option than those with chronic atrial fibrillation.

Dr. Cohen has trained a handful of surgeons from across Canada in the minimally invasive thoracoscopic Maze, but he is still the only one performing it here. For the moment, he says, its technical demands have limited its application.

Quick facts about atrial fibrillation:

  • Atrial fibrillation affects approximately 400,000 CanadiansThe risk of atrial fibrillation increases with age and it is estimated to affect three to five per cent of people over the age of 65
  • Atrial fibrillation often has no symptoms, but it can result in palpitations, fainting, dizziness, feeling overtired or chest discomfort
  • Atrial fibrillation is associated with a variety of conditions, including high blood pressure, coronary artery disease and heart valve disease
  • Approximately 15 to 20 per cent of strokes in people over age 70 are caused by atrial fibrillation