The Wolf Mini-Maze

The latest interventional procedure to treat AF is a minimally invasive operation called the "Wolf Mini-Maze." The "Mini-Maze" was developed by Dr. Randall K. Wolf, Professor of Cardiothoracic Surgery and Director of the Center for Surgical Innovation at the University of Cincinnati., using instruments that he helped design. Dr. Wolf's procedure combines an “ablation” method and the "maze" procedure, WITHOUT performing "Open heart surgery." 

Dr. Wolf developed this new minimally invasive procedure to cure AF without making an only 7 inch incision in the sternum or breastbone and without having to use the heart-lung machine. The mini-maze procedure is a much less invasive procedure, in which he enters the heart through small incisions between the patient’s ribs.

Dr. Wolf performs in fact two surgical procedures at one time. He uses a special "bi-polar" RF clamp to ablate and electrically isolate the pulmonary veins, where the triggers are located that activate AF. This ablation procedure is performed through two small “non-rib-spreading” mini-incisions, one on each side of the chest. The word "ablation" simply means to destroy tissue by burning it. This is done in a specific pattern. The chaotic electrical activity of the heart is halted because the electrical impulses cannot cross the burn scars that separate the areas of the atria. The "bi-polar" RF clamp is so efficient that he can perform an ablation in 8 seconds. An ablation would normally take up 3 minutes with a conventional unipolar RF head.The second part of the procedure is the endoscopic exclusion of the left atrial appendage, a useless “thumb-like” structure of the heart that can host clot formation that can lead to a stroke. Strokes due to AF are particularly devastating.

The devices are navigated by a micro-miniature television camera, so that Dr. Wolf can actually see the heart without opening the chest. The procedures performed at the University of Cincinnati were specifically focused on treating AF as a stand-alone condition. The new less invasive procedure allows patients who have suffered from long-standing intermittent AF to undergo a less invasive surgery to treat their AF and recover faster than traditional surgery for AF. Patients who undergo this procedure are expected to have hospital stays of only 2-3 days, compared to 7 days or more with conventional surgery.