Minimally invasive surgery for atrial fibrillation-Wolf Mini Maze procedure.

Abstract

The Cox-Maze III procedure has traditionally been considered the “gold-standard” in the surgical treatment of atrial fibrillation (AF). In an era of increasingly minimally invasive surgical techniques, proponents have highlighted advantages of reduced trauma, shortened hospitalization length and improved cosmesis. Developed by Dr. Randall Wolf, the Wolf Mini Maze procedure is a minimally invasive surgical approach, utilizing a video-assisted epicardial ablation. In 1999, we made a bipolar device from a Semb clamp and modified it with gold electrodes on the tips. The idea was that by placing the clamp between the ribs to surround the pulmonary veins for pulmonary vein isolation, a minimally invasive surgical approach could be achieved. An acute porcine model was initially used, with a sternotomy performed and clamp placed on the beating heart around the pulmonary veins. There are several advantages of such a clamp technique, including the exclusion of all of the blood while the clamp is being fired. We demonstrated transmural isolation of the pulmonary veins in 100% of the animals tested, particularly acute transmural lesions in the excised and stained cardiac tissue. This can be observed via cross-sections near the antrum and transmural lesions from the inside of the heart. Lastly, we also performed trichrome stains to demonstrate the scar, the basis for isolating AF triggers about the antrum. The trichrome stain can be clearly observed in the transmural lesion of the cardiac muscle. In 2001 in Leiden, we utilized a disposable bipolar clamp during concomitant procedures. Our goal was still to proceed with a minimally invasive approach for a stand-alone procedure.