The Cox-Maze & Mini-Maze Surgeries and the Hybrid Surgery/Ablation

This article, as the title indicates, discusses some of the merits and demerits of the different procedures for AF. It seems to suggest that that choice of a given procedure is not always a straightforward matter and that there is no "one size fits all" procedure-the choice needs to be made at the individual patient level. One issue raised is the comparative safety of the different procedures. The intention of posting this article is to provide a starting point for a more balanced discussion of the issues involved.

a-fib.com/treatments-for-at...

[CDreamer]

Looks like an excellent read for anyone contemplating the various treatments and which might be helpful for them.

The last statement was also good for thought

Be advised that some hospitals, medical services, web sites, etc. may promote the Mini-Maze over catheter ablation, because current reimbursement rates are higher for surgery (currently around $15,000 in the US) than for catheter ablation. Mini-Maze-type surgeries represent a huge and growing market and an important income source for hospitals, surgeons, medical device companies, web sites, etc.

[depotdoug in reply to CDreamer]

True I believe. More surgeriesmost hospital earnings. Then they can invest in more research and new method of treatments.

[CDreamer in reply to depotdoug]

Very sad state of affairs when monetary gain clouds or trumps clinical judgement.

[wilsond in reply to CDreamer]

Disturbing

[Poochmom in reply to CDreamer]

The MiniMaze also an important procedure with better success rates than catheter ablation. In relation to this I would make the argument that at 93% success rate for mini maze in the us being a one and done, if you add up three or four ablations I’m Not sure the cost is that much different.

[MummyLuv]

I really like this website and found it useful when deciding on which procedure was right for me. I would however flag that a lot of the data and research referred to is now quite out of date with most over 10 years old. The risks of surgery have reduced in this time and more recent studies find that the mini maze and hybrid procedures have significantly better outcomes than catheter for persistent. I’m happy to post the more recent study links if not too much x

[Hidden in reply to MummyLuv]

The more recent info would be very useful. Thanks.

[MummyLuv in reply to Hidden]

Here are a few papers and articles. There are more. For transparency I edited my post above as I had missed out surgery/hybrid better for persistent. This is not the case for earlier stage afib.

German paper on ablation surgery

pubmed.ncbi.nlm.nih.gov/345...

Netherlands surgical ablation centre results

academic.oup.com/europace/a...

Another Dutch study published in Dec looking at 5 year freedom rates for persistent afib

academic.oup.com/icvts/adva...

Surgery more effective in long term persistent than catheter ablation, UK paper

njl-admin.nihr.ac.uk/docume...

Sana heart centre stuttgart results

cardiacrhythmnews.com/promi...

Chat on why not widely accepted yet

thieme-connect.com/products...

Paper by Dr Van Bowen with review of surgical ablation in Netherlands, widely accepted there by cardiologists and done in number of centres

swiss-ablation.com/download...

This EP training also compares different recent studies, different ones to above

aerjournal.com/video-index/...

[CDreamer in reply to MummyLuv]

I wonder if that could be a pinned post? Questions about alternatives to ablation are becoming more frequent.

[MummyLuv in reply to CDreamer]

No idea how to do that, I may need admin help. Be great to have a resource section for stuff like this. I can’t tell you how many weeks of time that would have saved me 😂😂

[CDreamer in reply to MummyLuv]

Absolutely and other forums manage to do that.

[MummyLuv in reply to CDreamer]

The biggest and cross country trial into surgical ablation in Europe is the FAST trial, but it was back in 2012 so I haven’t included here. Lots of info in there if anyone is interested. The Netherlands a key contributor along with a hospital in Barcelona.

[Hidden in reply to CDreamer]

I’ve just made TracyAdmin aware of your suggestion…….

[wilsond]

Thank you for posting the info. There are always pros and cons in life!However, it is not easy to compare the merits of different proceedures as far being actually able to choose them. I am aware that there are some of the various maze options available for some suitable patients for whom other options such as meds or Cath. Ab. are not possible or appropriate,both here in the UK and elsewhere. However this is not a universal offer ,as Cath. Abs are in the UK.

It is pretty pointless for me ,and many others, in reality because it is simply not possible to access these on the NHS as routine ( unless you can meet certain criteria and if your local Trust approves it etc)

Trusts have to allocate funds as best they can,the fact that ablation is considered to be a Quality of Life proceedure as against life saving probably accounts for the sparse availability .

The cost of private care is prohibitive for the majority,so although I can sit and read all about this that and the other and recognise and admire the clever medical advances being made,it is irrelevant to my situation.

I'm sure in time to come ( fingers crossed for an NHS miracle) other options such as these may become more readily available.

[MummyLuv in reply to wilsond]

I think hybrids are the route to this, EPs and surgeons working together. This is what the NHS centres that do offer it are using. My local trust is currently training up to offer hybrid. I don’t see it being offered as an elective option for all, so far it has been offered for persistent afib and the UK EP conference I shared was looking at hybrid ablation as the new standard of care for persistent afib in the UK. It is coming….

[wilsond in reply to MummyLuv]

🤞🤞🤞

[Ducky2003 in reply to wilsond]

As you know, I was offered the Hybrid in Coventry until they found this pesky valve issue.Hopefully, you won't need to have further intervention.🤞