Mini Maze availability in UK

[KenRC]

For all those who left messages on Mini Maze I suggest you read this?

paulmodi.co.uk/surgical-pro...

[BobD Volunteer]

Apparently not the same as the Woolfe procedure.

[KenRC in reply to BobD]

Looks encouraging though…….

[MiniMeGreen]

The thoracic approach is pretty similar thus I wonder why he says he can't achieve the same result. There is missing information (also the papers he lists are well over 13 years old) and I generally prefer the rather modest people who don't have such a flashy advertisement but who do tell you exactly what they are doing and why.

There is one more guy like this making similar surgeries in Switzerland and opening such flashy centers also in Germany who didn't earn my trust.

However, this is a very personal impression I'm giving here, it may be that both of them are fantastic. Both do take private patients only as far I understand.

It's at least a push in the right direction though.

[Poochmom in reply to MiniMeGreen]

The big difference I see is there is no mention of ablating the ganglionic plexi which is what Dr Wolf does. He also does extensive testing during surgery to make sure everything is isolated including the LAA before closing up. It doesn’t leave a lot to chance except if AFib is coming from somewhere outside of his treatment area which does happen explaining why it’s not 100% effective.

[MiniMeGreen in reply to Poochmom]

Actually I wrote more above and that was deleted without saying why. I wondered about the number of people treated, the success rates and adverse events observed. Why wanting to know such things prior to a decision what to do is not allowed to say remains a mystery to me. It certainly dampers my willingness to engage.

[Buffafly in reply to MiniMeGreen]

Written in 2019 I see so well out of date by today’s standards. I do agree that the advert part is grating but that may be a cultural issue! The first part is worth a read for anyone confused about different types of AF.

He specialises in minimally invasive valve surgery and offers the Cox Maze but I get the impression that’s a bit of a sideline……

[MummyLuv in reply to MiniMeGreen]

I also consulted with Prof Salzburg if that’s who you mean, he operates between Switzerland and Germany. He prefers other options to be exhausted before surgical ablation.

[MiniMeGreen in reply to MummyLuv]

Yes, this is him, just one different vowel, he is not the city. He was mentioned to me by my cardiologist who however, didn't know the difference between Wolf MiniMaze and Cox Maze, which may be understandable since he doesn't operate himself. Anyway he said that he had one patient who insisted going there and almost didn't survive it. They did a reanimation while in surgery and got him back and performed the surgery. Unfortunately for this person, his AF returned after one year, poor chap.

It has to be clear to everybody that every surgery has risks, the Wolf MiniMaze slightly more than the catheter ablation and there is no guarantee that one will belong to the lucky ones who become AF-free for life.

However, I regard the risk-benefit ratio as a very good one in this case.

Dr. Wolf is complaining in his videos sometimes, that although he has very long AF-free survival rates, AF is considered incurable condition, while when you have lets say a cancer patient who after all therapy is cancer free 5 years later, it's called remission (basically disease free) while AF-free patient after 5 years is not. I think this a typical mainstream hypocrisy and I completely understand his complaint.

I don't consider Cox Maze being the best for me because my scars never do what is expected from them and I also prefer not to be on heart-lung machine, though Dr. Ohtsuka has it on standby if needed.

[MummyLuv in reply to MiniMeGreen]

lol, good old prescriptive text. Yes there are side effects for both. Last research I read said that they were not about 3% serious complication rate. Just different complications eg phrenic nerve damage with catheter, plural effusion with surgical ablation, since minimally invasive the risks of surgical ablation are no longer higher.

[MummyLuv in reply to MiniMeGreen]

Paul Modi takes patients on the NHS at Liverpool heart centre he is mainly a valve surgeon.

[MummyLuv]

there are a number of surgeons in the UK offering mini maze. Others who have experience are in Sheffield and Plymouth. Surgeons with less experience in Southampton, Newcastle to name a couple.

Mini maze just means PV isolation and box done without opening the chest, usually the left appendage is closed. There are various ways to do this as outlined in this article and the direction of travel in UK is for hybrids (totally thorosxopic maze with catheter ablation) used for persistent or stubborn AF. The CEASE-AF study has just been published on hybrid success.

The Wolf mini maze is not actually a mini maze as there is no box done. He instead ablates gamglionic plexi which research studies show is beneficial for paroxysmal but less so for persistent.

[Cabinessence in reply to MummyLuv]

Any idea on the results of the CEASE-AF study?

[Cabinessence in reply to Cabinessence]

Sorry I was being lazy. Herewith the study results published in the Lancet. thelancet.com/journals/ecli...

[MummyLuv in reply to Cabinessence]

They are pretty compelling for persistent

[Cabinessence in reply to MummyLuv]

Yes. 71.6% is good, but I thought Dr Woolf spoke about nearer 90%. Or is that across the range of sufferers and not those necessarily just those in persistent?

[Poochmom in reply to Cabinessence]

I believe the 90% is paroxysmal. For persistent I think it’s more 70-80% depending on length of time in persistent.

[Cabinessence in reply to MummyLuv]

A bit dated as well now I suppose, with the dates of procedures covering November 2015 to May 2020?

[MummyLuv]

gosh for research studies of this scale that is very recent. It takes time for peer review, publishing etc. the next stage is currently underway. They will continue to track for longer term data.

[Cabinessence]

What's the type of ablation you had done in Sheffield?

[MummyLuv in reply to Cabinessence]

The Sheffield based surgeon did mine privately in London, as I am in Scotland I can’t access the procedure on the NHS. I had a totally thoroscopic maze with left appendage closure 20 months ago. I shared my experience in here you click on my profile and look at posts if you are interested.

Good luck coming off Amiodarone, I hope your catheter ablation holds and you don’t need to go down this route.

[MummyLuv in reply to MummyLuv]

PS I had an unsuccessful catheter ablation first and 4 unsuccessful cardioversions, I was told I was not capable of NSR which led me to look for another option. Fist alternative I found was Dr Wolf’s as he thankfully takes time to create educational material, then I started research papers which taught me for long term persistent mini maze had double the success rate and no higher complications rate so was my best chance. I had consultations with several surgeons around the world. Feel free to PM.

[EngMac]

Thanks to the recent posts, even though I knew about the Wolf min maze, I did not investigate it. So now being more curious about the Wolf mini maze, I looked at a couple of videos on uTube. One is called Randall Wolf - Why Catheter Ablations Fail and the next video is one where he answers questions about the mini maze. These were both done in May/June 2022. There are also other videos. He is pretty fair in his views and does use catheter ablation for certain problems if needed. He has been doing these procedures for 18 years, always uses a clip to close the LAA, and does about 5 procedures a week. He is pretty thorough in assessing the patient's condition before agreeing to do the mini maze. So far he has not killed anyone which is a good record to have. And the results at getting rid of AF are very good. Unfortunately, for non-US citizens, the cost to have him do one is probably very high. I will send an inquiry, which he suggests if a person is interested, to see if I am a candidate; and, if so, what the cost could be. I am in Canada so the exchange rate adds 30% which is a big negative. In the US, EP doctors cannot do a mini maze; only cardiac thoracic surgeons can. This could be the reason EP doctors are not that familiar with this surgery.

He is the first person, I have learned, to be somewhat aware of the importance of the nerve communication between the brain and the heart, probably the vagus nerve. Heart surgeons look at the heart, and as far as I know, few if any health professionals investigate the nerves from the brain to the heart; and understand, in any detail, how they impact the heart's function and if a faulty communication could cause AF. For those of you who realize physical position can definitely influence AF, we keep hoping someone will. Maybe once the mapping of the vagus nerve is completed, some people may look into this.

[EngMac]

To make it easy, here is the link. Even if you don't agree, you may wish to listen to this video. Unfortunately, most of us do not have access to a competent doctor who can do the Wolf mini maze so no matter if what he says in this video is true, right now the ablation route can be our best option .

youtube.com/watch?v=TXw0g-k...(Not working as expected?)