Cor Vasa 2010, 52(Suppl.):66-69 | DOI: 10.33678/cor.2010.208

The endoscopic MAZE procedure - minimally invasive surgical treatment of isolated atrial fibrillation

Zbyněk Straka^1,*, Petr Budera¹, Pavel Osmančík², Martin Herold², Petr Brůček¹, Tomáš Vaněk¹

¹ Kardiochirurgická klinika, Kardiocentrum, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha

² III. interní-kardiologická klinika, Kardiocentrum, Fakultní nemocnice Královské Vinohrady a 3. lékařská fakulta Univerzity Karlovy, Praha, Česká republika

Aim: The MAZE procedure belongs to the most effective options in the management of atrial fibrillation. Given its technical complexity and the need for extracorporeal circulation, it has been performed almost exclusively as a procedure combined with heart valve surgery or bypass to date. This paper presents our initial experience with the endoscopic MAZE procedure for isolated atrial fibrillation.

Method: Two 10-mm and one 5-mm ports were inserted into the right hemithorax. The pericardium was incised longitudinally above the course of the phrenic nerve. Blunt trimming of the point whereby the vena cava superior passes through the pericardium was used to reach the transverse sinus and left appendage, while the same technique was employed to reach the oblique sinus below the vena cava inferior. A FLEX 10 microwave probe (Guidant, Santa Clara, CA, USA) or, currently, a newer COBRA XL radiofrequency catheter (ESTECH, San Ramon, CA, USA) was placed using a flexible endoscopic retractor around the origins of pulmonary veins, followed by sequential ablation. Antiarrhythmic therapy with Cordarone was initiated on the day of surgery, and antiplatelet therapy on the first postoperative day. Heart rhythm was checked using ECG and Holter monitoring at 6 and 12 months postoperatively.

Results: A total of 34 patients were operated on from November 2006 to the end of 2009. One-year follow-up data were obtained from 30 patients. Heart rate was assessed on the basis of 24-hour Holter monitoring data. In 16 (53%) patients, the recording showed permanent sinus rhythm, and nine had no antiarrhythmic therapy. Among the remaining 14 patients, paroxysmal and permanent atrial fibrillation was detected in 8 and 6 individuals, respectively. Overall, 21 (70%) patients reported no or only minimal complaints compared with their preoperative status. No serious intraoperative or postoperative complications were observed either.

Conclusion: Our initial experience shows that the endoscopic MAZE procedure is a safe and relatively effective method of managing atrial fibrillation.

Keywords: Atrial fibrillation; Endoscopic surgery; MAZE procedure

Published: December 1, 2010  Show citation