Surgical Ablation
Surgical ablation is a procedure that renders ineffective very precise, abnormal areas of heart tissue. One of the uses for surgical ablation is to prevent cardiac tissue from conducting abnormal heart rhythms, ensuring that the patient’s heart will beat more regularly. There are three primary types of surgical ablation: Cox-Maze procedure; standard surgical ablation; and, high-intensity focused ultrasound (HIFU) surgical ablation.
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Cox-Maze Procedure
With the Cox-Maze procedure, physicians make a precise pattern of incisions inside the right and left atria, and then they suture those incisions back together. This creates lesions of scar tissue that stop abnormal electrical activity from passing through the heart. Patients must be placed on a heart-lung bypass machine (on-pump) throughout the procedure. The Cox-Maze procedure is quite effective, but, because it is very challenging for physicians and invasive for patients, it is not used frequently.
Standard Surgical Ablation
Newer technologies have been developed that create cardiac ablation lesions without incisions and sutures inside the heart. These procedures may require clamping the aorta and/or placing the patient on-pump. They generally use gradient energy such as radiofrequency (RF), microwave, laser, and cryo (freezing) to decrease the invasiveness of the procedure, but they are not always as effective as the Cox-Maze method due to the difficulty involved in placing devices and the tendency of these techniques to create incomplete lesion sets.
HIFU Surgical Ablation
With high-intensity focused ultrasound energy, physicians can create very precise, consistent, and effective ablative lesions without stopping the patient’s heart. In this procedure, energy is applied to the outside of a beating heart. By adjusting power and wavelength, the energy is focused to ablate precise areas of cardiac tissue without impacting surrounding tissue or blood vessels, effectively creating continuous full-thickness lesions.
Surgical ablation is often performed on patients already receiving cardiac valve replacement or repair, or coronary artery bypass, due to the fact that a surgeon already has access to the patient’s heart. These procedures are referred to as concomitant (something that occurs concurrently with another thing). As HIFU surgical ablation enables less invasive procedures, increasing numbers of patients may become eligible for this as a standalone procedure.
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