Causes Of Afib - Evolution and Limitations of the Original Maze Procedure.
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The Maze procedure was first performed in 1987 by James Cox, MD. It was an open heart operation that was done to cure atrial fibrillation (Afib). The technique required stopping the patient's heart and connecting a heart-lung bypass machine to support blood circulation during the procedure. It was considered a breakthrough surgical technique at the time.
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Since then, maze surgery has evolved to incorporate minimally invasive techniques that preclude the need to arrest the patient's heart. This article will describe the procedure's evolution through the years. You'll learn how the original technique addressed Afib, as well as that method's limitations. We'll also take a brief look at the development of new energy sources and the introduction of the Mini-Maze.
The Purpose Of The Original Technique
As noted earlier, the original method was done to cure atrial fibrillation. This condition is defined as erratic electrical impulses that cause the atria to flutter. The surgeon used a scalpel to make a series of incisions into the surface of the atria. These incisions were then sewn back together to create scar tissue. This maze of scar tissue served as a conduction block, which "herded" the electrical impulses along a defined path from the sinoatrial node to atrioventricular node.
Because the electrical signals were forcibly guided down a defined corridor of scar tissue, they were prevented from spreading uncontrollably throughout the atria. Thus, the fluttering effect was eliminated.
Limitations Of Early Variants
The original technique soon evolved into a procedure now known as the Cox-Maze III. It was first performed in 1992 (again, to treat atrial fibrillation). While it was successful in curing Afib for the majority of patients who underwent the operation, it posed a number of significant drawbacks.
First, the procedure was still a form of invasive open heart surgery. That meant the patient's heart still needed to be arrested during the operation.
Second, making the incisions into the surface of the atria proved difficult for many surgeons. The technical challenges prolonged the surgery, which exposed the patient to a higher level of risk. This led to a higher-than-acceptable morbidity rate.
Because of these limitations, the technique was seldom performed on patients who suffered atrial fibrillation as a lone condition. Instead, these patients were encouraged to rely on blood thinners and other medications.
Development Of New Energy Sources
To address the technical challenges of performing the Maze procedure, new energy sources were developed. These energy sources eliminated the need to make atrial incisions with a scalpel. Microwave, laser, and high-frequency ultrasound were increasingly used to ablate the surface of the atria. While their use made the operation less invasive, it also posed a problem.
The Cox-Maze III was a reasonably standardized technique. Most surgeons who performed the operation did so in a consistent manner. With the introduction of new energy sources, this high level of consistency deteriorated. Surgeons performed maze surgery using different approaches. Predictably, its efficacy in successfully treating Afib declined.
Introduction Of The Mini-Maze Technique
The Mini-Maze was introduced in 2003 as a minimally invasive approach to maze surgery. It was an important development because the atrial conduction block could be achieved without stopping the patient's heart. Rather than cutting into the chest and separating the sternum, the technique was performed through a few small incisions. Moreover, because the entire operation could be completed within a few hours, the patient's recovery time was shorter.
The minimaze method is less than perfect because it still requires the surgeon to cut into a large amount of muscle. That said, as our understanding of the heart's anatomy and the root causes of atrial fibrillation grow, new techniques will be developed to cure the condition. Consult your physician to learn about the latest developments in the Maze procedure.
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