Posted by John Behle on January 06, 2003 at 00:02:08:
In Reply to: Re: Dr. Cox & the Texas Heart Institute posted by Beverly Crane on January 05, 2003 at 07:16:28:
Your assumption that the Mini Maze is more advanced or somehow the surgeons are more advanced may not be the case. Also, without details on your lung problems, it is hard to address, but there is a possibility it might make you LESS of a candidate for the Mini Maze.
My surgeon in Salt Lake, Dr. Millar does only the full open chest MAZE procedure. I never knew why at the time I just knew I had confidence in him so I never went into detailed questioning as to his reasons.
The LDS Hospital where he practices has many videos and papers online. I was interested to see that the surgeons he practices with are actually pioneers in non-invasive heart surgery and are making great strides. They do many procedures without the full chest incision that are not done elsewhere.
So, it begs the question of "why, if they are pioneers in this area would the surgeon prefer the open chest procedure?" At first, I assumed it is a somewhat standard procedure since most of his MAZE surgery is also with valve replacements, etc.
As I've watched the MAZE procedure and read the forum here and many of the articles in medical journals, It appears that there may be greater safety and success in the full open chest MAZE. I read of one case where a nerve was cut or damaged that appeared to be related to the cramped quarters of the mini MAZE. It also seems that there are more cases needing a "touch up ablation" particularly of an area that is extremely hard to reach using the Mini MAZE. Several have remarked as to it actually being more painful and having a longer recovery. There is the factor of having to be on the Heart Lung machine LONGER in the case of a Mini MAZE also.
I haven't seen where a surgeon has taken a strong stand or opinion relating to safety or success issues between the two surgeries. They seem to have their preferences one way or another, but those that do the Mini MAZE still opt for the full open chest procedure in some cases.
One of those same areas that is hard to access in the Mini MAZE seems to be problematic as to the cryoablation not fully doing the job in some cases.
I headed towards the MAZE as fast as I heard about it and without time for extensive study or understanding. I somehow assumed that the "cut and sew" was the standard, when in reality, cryoablation has been pretty much the norm for a while.
There was a news piece about my surgeon and about the cryoablation. I became concerned that somehow I might be some kind of guinea pig for a new procedure. Dr. Millar cleared it up for me - actually called me at home on a Sunday night to answer my questions. If there are true medical professionals and humanitarians in the medical world, they are some of these incredible MAZE surgeons. At my six month check up and 6 months of NSR, he seemed almost tearful about my success and those of the other patients he had helped.
I later read an article of Dr. Millar's that described how he uses cryoablation on most areas, but the "cut and sew" on one or a couple areas that do not respond as well to the cryoablation. That may be part of the motivation behind using the full open chest procedure while at the same time being one of the pioneers in less invasive heart surgery.
As to lung problems, it seems to me, that I also read that the Mini MAZE involves collapsing one of the lungs to make more space? I'm sure someone will beat me senseless with a PDR if that is incorrect, but if that is the case, it may factor into your decision given whatever the lung problem might be.