The Mei mini-maze procedure

2020 ◽  
Vol 28 (7) ◽  
pp. 416-420
Author(s):  
Zhaolei Jiang ◽  
Nan Ma ◽  
Min Tang ◽  
Hao Liu ◽  
Shiao Ding ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Maze Procedure ◽  
Surgical Trauma ◽  
High Morbidity ◽  
Radiofrequency Energy ◽  
Thoracoscopic Approach ◽  
Left Chest ◽  
Video Assisted ◽  
Left Pulmonary Vein ◽  
The Right

Atrial fibrillation is a common clinical arrhythmia with high morbidity and a risk of stroke. The Cox-maze IV procedure that uses radiofrequency energy for ablation is established as an effective way to eliminate atrial fibrillation. Compared to the Cox-maze IV procedure, the video-assisted Wolf mini-maze procedure is associated with reduced surgical trauma, but still requires bilateral thoracotomies, and the ablation line connecting the right and left pulmonary vein isolations cannot be created with a bipolar ablation clamp. We have developed a novel video-assisted mini-maze technique that uses a unilateral (left chest) thoracoscopic approach (the Mei mini-maze procedure).

scholarly journals An off-pump biatrial mini-maze procedure for treatment of long-standing persistent atrial fibrillation

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
T Yan ◽  
S.J Zhu ◽  
M Zhu ◽  
C.F Guo
Keyword(s):  
Atrial Fibrillation ◽  
Left Atrial ◽  
Vena Cava ◽  
Persistent Atrial Fibrillation ◽  
Maze Procedure ◽  
Purse String ◽  
Off Pump ◽  
Bipolar Radiofrequency ◽  
The Right

Abstract Background Surgical treatment has assumed a more prominent role in the therapy of atrial fibrillation (AF) with favorable efficiency and acceptable safety during the last decades. The traditional Cox-Maze procedure and Wolf Mini-Maze procedure focused on left atrial ablation. However, it is ubiquitous that patients with long-standing persistent atrial fibrillation (LSPAF) typically suffer from biatrial electrical and structural remodeling. The left atrial procedures are still not enough in patients with LSPAF. Purpose Herein, we aimed to introduce a modified biatrial off-pump ablation procedure based on the Wolf Mini-Maze procedure and to detect the safety and efficacy of the surgery for patients with LSPAF. Methods Between January 2016 and September 2020, 102 patients of LSPAF underwent our modified Mini-Maze procedure using bipolar radiofrequency ablation. Those patients firstly underwent a Mini-Maze procedure using Dallas lesion set, including video-assisted bilateral mini-thoracotomy, left atrial appendage excision, bilateral pulmonary vein isolation, ganglionic plexi evaluation and destruction, left atrial roof connecting lesion, and a linear lesion connecting this roofline to the root of the aorta at the junction of the left coronary and the non-coronary cusp. Secondly, a purse-string suture was performed on the right atrium, and then four ablation lesions were made to the superior vena cava, to the inferior vena cava, to the appendix of the right atrium, and to the tricuspid valve annulus from the purse-string suture point by the bipolar radiofrequency clamp. After the operation, the patients were followed up at an interval of 3, 6, 12 months, and every 1 year after that. Results No mortality No surgical re-exploration for bleeding. No permanent pacemaker implantation. 99 patients were free from LSPAF upon discharge. A follow-up at interval of 3, 6, 12, 24, 36, and 48 months showed a success rate free from LSPAF was 95.1% (97/102), 94.4% (85/90), 94.8% (73/77), 91.5% (54/59), 90.3% (28/31) and 100% (9/9), respectively Conclusions The modified biatrial Mini-Maze suggested a safe and feasible procedure. Early follow-up demonstrated an acceptable success rate free from AF. It might have the potential to become another option for clinical treatment of LSPAF. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): General Program of the National Natural Science Foundation of China Schematic of the procedure

Cone repair for Ebstein’s anomaly and atrial fibrillation ablation in an adult patient

2021 ◽  
Keyword(s):  
Atrial Fibrillation ◽  
Tricuspid Valve ◽  
Pulmonary Veins ◽  
Maze Procedure ◽  
Right Atrial ◽  
Ebstein’S Anomaly ◽  
Ebstein's Anomaly ◽  
Previously Treated ◽  
Cone Repair ◽  
The Right

We present a 52-year-old woman with Ebstein’s anomaly not previously treated. In this subset of patients, there are no clear guidelines regarding the best surgical strategy for treating the tricuspid valve: replace it or repair it. In this case, extensive repair of the tricuspid valve and the right ventricle is achieved using the cone repair technique popularized by Dr. José Pedro Da Silva. Because the patient also presented with symptomatic paroxysmal atrial fibrillation, a right atrial maze procedure combined with isolation of the pulmonary veins was performed using both radiofrequency and cryotherapy. At the last follow-up, 2 years after the repair, the patient is asymptomatic and maintains sinus rhythm. The last echocardiogram showed mild tricuspid regurgitation with normal right ventricular function.

scholarly journals TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy

2014 ◽  
Vol 2 (1) ◽  
pp. 34-37
Author(s):  
Andrew W Murray
Keyword(s):  
Transesophageal Echocardiography ◽  
Right Atrium ◽  
Hemodynamic Instability ◽  
Hemodynamic Stability ◽  
Right Heart ◽  
Thoracoscopic Approach ◽  
Video Assisted ◽  
Pulmonary Vasoconstriction ◽  
The Right ◽  
Midline Sternotomy

ABSTRACT Thymectomies have traditionally been performed via a midline sternotomy but are now increasingly being conducted via a thoracoscopic approach. Insufflation of CO2 into the hemithorax during this procedure can create severe compression of the right atrium and ventricle with resultant hemodynamic instability as well as lead to hypercapnia with possible pulmonary vasoconstriction and right heart strain. Transesophageal echocardiography allows monitoring of both the effects of CO2 insufflation on the heart and the efficacy of interventions to restore hemodynamic stability. How to cite this article Murray AW, McHugh SM. TEE Effects of CO2 Insufflation during Video-Assisted Thoracoscopic Thymectomy. J Perioper Echocardiogr 2014;2(1):34-37.

scholarly journals Localized Pulmonary Vein Scar Promotes Atrial Fibrillation in High Left Atrial Pressure

2021 ◽  
Vol 12 ◽  
Author(s):  
Lisa A. Gottlieb ◽  
Fanny Vaillant ◽  
Emma Abell ◽  
Charly Belterman ◽  
Virginie Loyer ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Pulmonary Vein ◽  
Left Atrial ◽  
Radiofrequency Energy ◽  
Stimulation Threshold ◽  
Healthy Sheep ◽  
Chamber Working ◽  
Wall Deformation ◽  
The Right ◽  
Working Heart

BackgroundPulmonary vein (PV) ablation is unsuccessful in atrial fibrillation (AF) patients with high left atrial (LA) pressure. Increased atrial stretch by increased pressure is proarrhythmic for AF, and myocardial scar alters wall deformation. We hypothesized that localized PV scar is proarrhythmic for AF in high LA pressure.MethodsRadiofrequency energy was delivered locally in the right PV of healthy sheep. The sheep recovered for 4 months. Explanted hearts (n = 9 PV scar, n = 9 controls) were perfused with 1:4 blood:Tyrode’s solution in a four-chamber working heart setup. Programmed PV stimulation was performed during low (∼12 mmHg) and high (∼25 mmHg) LA pressure. An AF inducibility index was calculated based on the number of induction attempts and the number of attempts causing AF (run of ≥ 20 premature atrial complexes).ResultsIn high LA pressure, the presence of PV scar increased the AF inducibility index compared with control hearts (0.83 ± 0.20 vs. 0.38 ± 0.40 arb. unit, respectively, p = 0.014). The diastolic stimulation threshold in high LA pressure was higher (108 ± 23 vs. 77 ± 16 mA, respectively, p = 0.006), and its heterogeneity was increased in hearts with PV scar compared with controls. In high LA pressure, the refractory period was shorter in PV scar than in control hearts (178 ± 39 vs. 235 ± 48 ms, p = 0.011).ConclusionLocalized PV scar only in combination with increased LA pressure facilitated the inducibility of AF. This was associated with changes in tissue excitability remote from the PV scar. Localized PV ablation is potentially proarrhythmic in patients with increased LA pressure.

Abstract TP417: Minimally-Invasive Video-Assisted Ligation of Left Atrial Appendage in Atrial Fibrillation: Stroke Prevention Strategy

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Basel Ramlawi ◽  
Kareem Bedeir ◽  
Luis Garcia-Morales ◽  
John Volpi ◽  
Mahesh Ramchandani ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Minimally Invasive ◽  
Stroke Prevention ◽  
Left Atrial ◽  
Left Atrial Appendage ◽  
Average Length ◽  
Prevention Strategy ◽  
Atrial Appendage ◽  
Thoracoscopic Approach ◽  
Video Assisted

Background: Non-valvular atrial fibrillation (AF) is a leading cause of embolic stroke, especially in the elderly population. The vast majority of thrombo-emboli in AF patients originate within the left atrial appendage (LAA). Effective and complete isolation of the LAA has been demonstrated to have a similar stroke-reduction effect as chronic anticoagulation. This study presents our initial experience with a novel minimally-invasive video-assisted (MIVA) thoracoscopic approach to epicardially isolate the LAA using the AtriClip device. Methods: Six consecutive AF patients (mean age 73.6 years, 3 of 6 male) with contra-indication to systemic anticoagulation underwent epicardial ligation of LAA using the AtriClip device. Procedure involved two 5mm ports and one 15mm port with application of the device at the base of the LAA under direct visualization. Immediate intra-operative confirmation of LAA isolation via trans-esophageal echocardiography (TEE) was obtained. Anticoagulation was not restarted post-operatively. Results: Average procedure length was 43mins and average length of stay was 72hours. All six patients had a non-complicated post-operative course. No stroke, myocardial infarction, renal failure or re-operation was encountered. No transfusions were needed. All patients were extubated in the operating room at conclusion of procedure and were ambulatory on the first postoperative day. 3 of 6 patients experienced excessive pleural drainage lasting 2-4 days postoperatively. TEE confirmation of complete LAA obliteration was achieved in all patients. Conclusions: MIVA LAA ligation appears to be a safe, effective and simple procedure to isolate the LAA in AF patients with contra-indication to anticoagulation. A multi-institutional trial to assess the efficacy of MIVA LAA ligation as a stroke prevention strategy is warranted and forthcoming.

scholarly journals Modified mini-maze via left thoracic cavity under VATS for paroxysmal atrial fibrillation in a patient with complete interruption of the inferior vena cava

2021 ◽  
Author(s):  
Fan He ◽  
Bijun Xu ◽  
Shiqiang Wang ◽  
Huai-Dong Chen ◽  
Weimin Zhang
Keyword(s):  
Atrial Fibrillation ◽  
Radiofrequency Ablation ◽  
Inferior Vena Cava ◽  
Left Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Maze Procedure ◽  
Thoracic Cavity ◽  
Left Chest ◽  
Bipolar Radiofrequency

Objectives: We sought to determine the technical feasibility of surgical bipolar radiofrequency ablation (endoscopic maze procedure) through the left chest cavity in patients with an interrupted inferior vena cava (IVC). Methods and Results: A 57-year-old female with paroxysmal atrial fibrillation (AF) and an interrupted IVC was referred to our hospital for radiofrequency ablation. Transseptal puncture and left atrium (LA) ablation failed through a standard IVC approach via the femoral vein due to intrahepatic interruption of IVC. We performed a modified surgical bipolar radiofrequency ablation (RF) on the beating heart through 3 ports in the left chest wall. Pulmonary vein isolation and ablation of the left atrium were achieved by bipolar radiofrequency ablation. Ganglionic plexus ablation was completed using the ablation pen. The left atrial appendage was excluded. No complications occurred during or after the procedure. The patient was discharged with sinus rhythm 3 days later after the procedure. She was taking amiodarone (100mg bid) within 6 months after the procedure, and had no recurrence of AF. Conclusions: We successfully performed a modified mini-maze procedure in a patient with paroxysmal AF and IVC interruption through the left thoracic cavity under video-assisted thoracoscopic surgery (VATS). We can successfully complete pulmonary vein (PV) isolation, left atrium box isolation, cardiac ganglia ablation, Marshall ligament ablation, and coronary sinus epicardium ablation using this technique.

Video-Assisted Thoracoscopic Monitoring of Laser Lead Extraction by Femoral Route

2018 ◽  
Vol 13 (3) ◽  
pp. 233-235 ◽  
Author(s):  
Luca Bontempi ◽  
Francesca Vassanelli ◽  
Manuel Cerini ◽  
Lorenza Inama ◽  
Gianfranco Mitacchione ◽  
...  
Keyword(s):  
Excimer Laser ◽  
Implantable Defibrillator ◽  
Lead Extraction ◽  
Bleeding Complications ◽  
Thoracoscopic Approach ◽  
Video Assisted ◽  
Myocardial Wall ◽  
Ventricular Lead ◽  
Femoral Route ◽  
The Right

A 72-year-old man with a dual-chamber implantable defibrillator was referred to our center for transvenous lead extraction because of pocket infection and presence of an abandoned lead. We decided to proceed with a video-assisted thoracoscopic approach because of patient history and documented complete occlusion of the right subclavian vein. During the use of excimer laser for persistent adhesions, the ventricular lead broke down at the level of cavoatrial junction. To successfully remove the remaining portion of lead, we decided to use the excimer laser by femoral route. A final angiography through the laser sheath showed the integrity of the myocardial wall. We report a case of laser-assisted transvenous lead extraction unconventionally performed by the femoral route. A preventive minimally invasive cardiac surgery was implemented to provide more safety in this high-risk procedure. This technique may avoid the need of a full sternotomy in case of major bleeding complications.

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