The “MiniMaze” Wolf technique
Dr. Randall K. Wolf, M.D., FACS
Professor, Cardiothoracic Surgery
Director, Center for Surgical Innovation,
University of Cincinnati Surgeons, Inc.
The latest interventional procedure to treat AF is a minimally invasive operation called the "Mini-Maze." The "Mini-Maze" was developed by Dr. Randall K. Wolf, professor of cardiothoracic surgery and director of UC’s Center for Surgical Innovation, using instruments that he helped design. Dr. Wolf's new approach “the Wolf Mini-Maze” procedure combines an “ablation” method and the "maze" procedure, without performing "open heart surgery."
Dr. Wolf performs two surgical procedures at one time. He uses a special "bi-polar" radio frequency (RF) clamp to ablate and electrically isolate the pulmonary veins, where the triggers are located that initiate AF. Ablation is performed through two small “non-rib-spreading” mini-incisions, one on each side of the chest. The word "ablation" simply means to destroy tissue by burning it. This is done in a specific pattern. The chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the burn scars that separate the areas of the atria. The "bi-polar" RF clamp is so efficient that an ablation can be performed in 8 seconds. An ablation with a conventional unipolar RF head would normally take about 3 minutes.
The ablation part of the procedure is the endoscopic exclusion of the left atrial appendage, a “thumb-like” structure of the heart that can host clot formation which can lead to a stroke.
The devices used in this procedure are navigated by a micro-miniature camera, which allows Dr. Wolf the ability to see the heart without opening the chest. The procedures performed at The University Hospital were specifically focused on treating AF as a stand-alone condition. The new less invasive procedure allows patients who have suffered from long-standing intermittent AF to undergo a less invasive surgery to treat their AF. This also permits faster recovery than traditional surgery. Hospital stays range 2-3 days, compared to 7 days or more with conventional surgery.
Atrial Fibrillation is widely known as, the most common, sustained cardiac arrhythmia. Atrial Fibrillation affects an estimated 2.5 million patients in the U.S. with approximately 300,000 new cases diagnosed per year. It is predicted that 5.6 million patients will be diagnosed with atrial fibrillation by the year 2050.
Dr. Wolf states, “I have been evolving this technology and technique for the past four years, and am very optimistic and excited about initiating this technique for patients at the University of Cincinnati Hospital. It gives us a curative treatment for atrial fibrillation without conventional heart surgery and without the heart-lung machine.
|
Surgeons and Electro-physiologists debate new Atrial Fibrillation Procedure Cincinnati— Nationally recognized surgeons and cardiologists debated the merits of a new, innovative procedure to treat Atrial Fibrillation (AF) with minimally invasive techniques via the Internet at November 16, 2004. Drs. Randall K. Wolf, professor of surgery and biomedical engineering at the University of Cincinnati, and his colleague Dr. E. William Schneeberger, associate professor of surgery, demonstrated this new procedure and lead a discussion of its merits with noted electrophysiology cardiologists, Dr. Warren Jackman, professor of medicine at University of Oklahoma and Dr. Richard Henthorn of Greater Cincinnati Cardiovascular Consultants. A video of the surgical procedure and discussion can be seen by viewing the link below. This video is approximately one hour and is accessible around the world through Internet access. This is the fourth Internet broadcast of surgery from The University Hospital and UC Surgeons, Inc. "Consumers are taking advantage of online resources regarding their health care, and we see this as a way to help meet those needs,” says Jeffrey B. Matthews, M.D., Chairman of the UC Department of Surgery. “Physicians can also benefit by receiving patient treatment education right at their desk. Technology is allowing us to bring information in real time to those seeking it.” Drs. Wolf and Schneeberger developed this “Mini-Maze” procedure with AtriCure (West Chester, OH) over the past several years. This procedure has been proven effective to cure AF without opening the breast bone and without using the heart-lung machine. Dr. Wolf made the statement, “I am excited that our several years of research and development have culminated in a truly minimally invasive option for patients with some forms of AF, this procedure is making waves in the cardiac community. I am so pleased that Dr. Jackman and Dr. Henthorn were available to participate in this discussion and provide patients with both the medical and surgical perspectives.” AF is one of the most commonly sustained cardiac arrhythmias, or irregular heartbeat. It affects an estimated 2.5 million patients, with approximately 300,000 new cases per year diagnosed. It’s predicted that 5.6 million patients will be diagnosed with AF by the year 2050. The risk of stroke in patients with AF is estimated at 7 times greater than patients without AF. AFis second only to heart failure in terms of cardiac related hospitalizations. Dr. Wolf performed the first case in the US using this “Mini-Maze” technique at The University Hospital in Cincinnati in August 2003. Since then more than 200 patients have undergone this procedure. The procedure and technology are designed to treat AF in patients who are non-responsive or suffer from disabling side effects of drug therapy. These were the first patients treated in the US using AtriCure’s technology without open heart surgery, and with the removal of the left atrial appendage, a small, but unneeded part of the heart, where blood clots might tend to form. In the case presented via the Internet roundtable, as in all cases performed to date at the University Hospital, surgeons used the ISOLATOR™ clamp which generates bipolar radio frequency in order to isolate specific cardiac structures responsible for AF. The isolation procedure was performed using minimally invasive video assisted instruments. The instruments are inserted into the chest through two small incisions, one on each side of the chest. The ISOLATOR™ clamp uses radio frequency energy to isolate a precise area of the heart tissue and interrupt the abnormal circuits that cause the irregular heartbeat. During the procedure, the left atrial appendage, a suspected major source of cardioembolic stroke in AF patients, was also removed. The traditional Maze procedure has been used world-wide to treat AF, but until now its use has been primarily for patients with AF who were undergoing major open heart surgery for other cardiac diseases. The new less invasive “Mini-Maze” procedure allows patients who have suffered from long-standing on-again, off again or chronic AF to undergo a less invasive surgery to cure their AF and recover faster than tradition surgery for AF. Patients who undergo this procedure have hospital stays of two to three days, compared to seven or more with conventional surgery. Medicare, Medicaid and private insurers cover the procedure. Dr. Wolf serves as the executive director of University of Cincinnati’s Center for Surgical Innovation. In addition, he is a clinical member of the UC Heart & Vascular Center and UC Surgeons. The Center for Surgical Innovation is a partnership between UC’s College of Medicine and Engineering, industry and government to develop new technologies in biomedical and surgical care to improve healthcare outcomes.
|
|
IF YOU VISIT THESE LINKS Read the article about Dr.Wolf in The Cincinnati Enquirer SEE THE LOCAL 12 WKRC-TV NEWS COVERAGE OF HIS PROCEDURE IF YOU VISIT THESE LINKS |