Stanford Health Care – Valley Care surgeon repairs patient atrial fibrillation using invented procedure | Information Center


Richardson convinced his doctor to allow his wife to drive him to Memorial Medical Center in Modesto, where he was admitted to the intensive care unit. For three days, the doctors repeatedly tried to return her heart to a normal rate. They gave him various combinations of drugs, but to no avail. Then they sent electric currents through her heart through paddles stuck to her chest – a procedure called electrical cardioversion. After four attempts and four failures, they abandoned this approach.

“My doctors were a little confused,” Richardson said. “I just wanted to get the hell out of the hospital.”

Her heart needed more help. When a cardiologist at Memorial Medical Center told him about a minimally invasive heart surgery called a total thoracoscopic maze, or TT maze, he wanted to know more. His other option was open heart surgery, which he wanted to avoid.

The TT maze was invented by James longoria, MD, cardiothoracic surgeon and clinical associate professor now at Stanford School of Medicine. Richardson met Longoria and her team at Stanford Health Care – ValleyCare in Pleasanton, about an hour’s drive from Modesto, and agreed to undergo the procedure.

“When other treatment modalities fail for people with atrial fibrillation, patients usually end up seeing someone like me,” said Longoria, who joined ValleyCare last year, with the opening of the hospital heart surgery clinic.

When surgery is needed

It is not known why the abnormal electrical signals that cause atrial fibrillation occur, Longoria said, although factors such as diabetes, high blood pressure and obesity may increase the risk. The abnormal electrical signals prevent regular blood flow from the upper chambers of the heart, the atria, to the lower chambers or the ventricles. Blood can collect in the atria and form clots. If a clot gets to the brain, it can cause a stroke.

For atrial fibrillation that does not respond to lifestyle changes and medications, a type of open heart surgery called Cox-labyrinth The procedure has been available for decades. After a patient’s heart has been stopped and placed on a heart-lung machine, which circulates oxygenated blood to the body, the surgeon makes a series of incisions inside the atria. which act as a “labyrinth” for electrical signals. The abnormal electrical signals bounce off the scar tissue from the incisions and are forced to self-correct in a normal pattern. For patients with atrial fibrillation who are already considering open heart surgery for other reasons, such as valve repair, the procedure is recommended. But for those like Richardson, less invasive versions, such as the TT Maze, are now an option.

“I didn’t want them to have to open my chest,” Richardson said.

The punch

To perform the TT maze, a surgeon uses special instruments to make small incisions on the sides of the chest to access the heart, deflate the lungs, and open the paricardial sac that surrounds the heart. Using an endoscope – a tiny camera attached to a long, thin tube – to guide it, the surgeon then applies ablation techniques using heat or cold to create a scar pattern on the outside of the heart. in order to disturb irregular electrical patterns. No heart-lung machine is needed. Longoria filed for a patent for the procedure in 2008, and it is now in use in hospitals across the country.

“What you want is to create roadblocks and allow the natural impulses to come back,” Longoria said. “The scar tissue that we form creates blockages to these aberrant signals, and they self-terminate by entering the scar tissue.”

If the atrial fibrillation returns, as it did for Richardson, another step is recommended about three months after surgery: a non-surgical procedure called endocardial catheter ablation. Small, flexible catheters are inserted into several veins, usually in the groin, and directed to areas inside the heart that cannot be accessed using the TT maze procedure. Electrodes at the ends of three or four catheters stimulate the heart to locate the area that sends the abnormal electrical signals. Then the doctor kills the heart tissue causing the problem with extreme heat or cold.

“With this hybrid staged ablation, as we call it, you first get the TT maze procedure, and then about three months later you come back for the catheter ablation,” Longoria said. “We call it the one-two punch.”

Go home

Longoria performed the Richardson TT Maze Procedure on July 6, 2020, at ValleyCare. His family drove him to hospital, but due to the pandemic they had to wait in their car while a nurse came out to update them. He was transported around 7 a.m. In the early afternoon, Longoria came out into the parking lot to announce that the operation had gone well.

“I had about five or six hits coming out of me,” Richardson said. “They collapsed both lungs for the surgery. I was beaten enough afterwards.

It wasn’t quite the end of his atrial fibrillation, however. About seven days after the operation, he was back at Modesto Hospital for electrical cardioversion. This time it worked. The same happened another week later, and again the treatment worked.

Then, at the end of the summer of that year, he suffered a catheter ablation to Modeste. Since then, he no longer has atrial fibrillation.

About two months later, he was able to stop his meds, Richardson said. “As far as my doctor is concerned, my heart is healed. I cannot thank Dr Longoria and his team enough.

Richardson lost 25 pounds during his hospitalizations and has since lost 25 more, bringing him down to 250 pounds. He’s eating healthier and drinking less alcohol, he said, and he plans to return to work part-time in a month or two.

“I am improving day by day,” he said.


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