The thoracoscopic left atrial maze (TT-maze) is a minimally invasive surgical procedure for the treatment of atrial fibrillation, with promising results in terms of continued freedom from disease. The TT-maze consists of a bilateral, epicardial pulmonary vein isolation with the creation of a box using radiofrequency and exclusion of the left atrial appendage (LAA). Also, the box is connected with the base of the LAA and furthermore with the mitral annulus with the so-called trigonum line. In this tutorial, we describe our surgical approach and short-term results.
It is as effective as the conventional Cox Maze surgery. The ideal candidates for thoracoscopic minimally invasive maze surgery are patients without any other cardiac problems other than atrial fibrillation.
Thoracoscopic Maze surgery does not require open heart surgery and can be performed on the beating heart through 3-4 small incisions on either side of the chest. These provide good access to the necessary surgical area around the heart. Surgical instruments, an ablation device, and thoracoscope are inserted through these small incisions, over the chest. The thoracoscope provides the surgeon with real-time, transparent, magnified images of the heart. A surgical ablation device is then used to electrically isolate the segments of the heart responsible for atrial fibrillation or abnormal hart rhythm into separated compartments.
The whole procedure takes a few hours.
As the surgery is performed through small incisions, it minimises trauma and has the advantage of more minor scars, decreased the risk of infection, less bleeding, reduced requirement of transfusion, less post-operative pain, fast recovery, shorter hospital stay and quicker return to daily routine activities. Since a heart-lung machine is not used the risk of stroke and renal failure is also reduced and the incidence of cognitive side effects is too low.