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Billings Clinic Performs First Mini-Maze Surgery in Region

Minimally Invasive Procedure Treats Atrial Fibrillation: Local businessman is able to increase quality of life to spend time with family and run his own successful business.

Billings, MT, December 19, 2008 --( On July 19, 2008, C. Scott Needham, MD, a cardiothoracic surgeon at Billings Clinic, performed a new procedure to stabilize abnormal heart rhythm caused by atrial fibrillation. Billings Clinic is the only hospital in Eastern Montana to offer the Mini Maze operation. The procedure called Mini-Maze involves electrical isolation of the pulmonary veins and removal of the left atrial appendage in order to restore normal cardiac rhythm. The surgery uses a minimally invasive technique that requires only a 3 cm incision in the upper chest just below the armpit and two smaller incisions that are less that 1 cm in length on each side of the chest. This procedure reduces the risk of stroke associated with atrial fibrillation and restores the heart to a normal regular heart beat.

Atrial fibrillation is caused by abnormal uncoordinated electrical impulses that stimulate the atria causing an abnormal heart beat. The Mini Maze procedure involves creating a series of barriers to construct a “maze” for the path of normal electrical impulses. The maze is created by ablating tissue that sends the abnormal electrical impulses to the two atria, the upper chambers, of the heart.

At Billings Clinic, a team of doctors that includes cardiologists, cardiac electrophysiologists and cardiovascular surgeons treat atrial fibrillation. Treatment options to restore the heart to normal rhythm are medications (to include coumadin), non-surgical procedures and surgical procedures. Working together, the Billings Clinic physicians determine the best option for each patient.

“Atrial fibrillation is complex and cannot be viewed as a condition that has one simple presentation that requires only one consistent treatment,” said Scott Sample, DO, Chair of Billings Clinic Department of Cardiology. “By having a team of doctors from different areas of expertise, we are able to collectively address the specific needs for each patient and the benefits provided by each of our treatment options for atrial fibrillation.”

When patients presents with atrial fibrillation they are referred to a cardiologist who will consult with the electrophysiologist and cardiovascular surgeon. In the case of Heiko Kaas, Lynn Otto, MD, electrophysiologist at Billings Clinic, recommended that Mr. Kaas see Dr. Needham about a new surgical option for treatment offered at Billings Clinic.

Heiko Kaas, a Billings business man who owns and runs his own bakery, was assessed and determined to be a perfect candidate for the Mini-Maze procedure. Tired of living with the myriad of problems that accompany atrial fibrillation; Mr. Kaas accepted the surgical option on July 19, 2008. Following an event free operation, Mr. Kaas stayed in the hospital for three days then went home in normal heart rhythm and with a great prognosis. Mr. Kass returned to work one week later and today, Mr. Kaas is back at work feeling healthy and energetic.

“This surgery is the most comprehensive solution available for patients with atrial fibrillation,” said Dr. Needham. “Completely attacking all nerves and ganglia that can affect rhythm and creating ablation lines that surrounds the pulmonary veins provides complete blockage of the electrical impulses that cause atrial fibrillation.”

Frequently, atrial fibrillation is the result of electrical impulses that originate from ganglia (nerve endings) located adjacent the pulmonary veins. During this procedure the surgeon completely isolates the pulmonary veins at the atrial junction and detects the ganglia that are abnormally stimulating the atria. Ablating these ganglia supports complete blockage of the electrical impulse that can result in atrial fibrillation.

The final component of the procedure is the removal of the left atrial appendage. This extra tissue serves no purpose to the function of the heart and can add significant risk of stroke by providing an area for clot formation. By removing this appendage, the risk of stroke is minimalized and the use of coumadin may be discontinued.

The Mini Maze procedure does not require the opening of the entire chest cavity. Incisions are limited to three small incision sites. Hospital stay is usually 3 to 4 days. The operation takes 3 to 4 hours and does not involve radiation. For the three types of atrial fibrillation, paroxysmal, persistent and permanent, success rates are improved from other forms of therapy. For instance, the Mini Maze surgery has a success rate of 97% for paroxysmal, or intermittent, atrial fibrillation.

Atrial fibrillation is the most common arrhythmia affecting more than 2.2 million people in the United States. Physicians are seeing 160,000 new cases annually with largest increase of atrial fibrillation presenting in our elderly population. Atrial fibrillation increases risk for stroke, heart failure and mortality.

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Billings Clinic
Julie Burton

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