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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.
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 stand alone procedure.
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What to Expect Before Surgical Ablation?
As with any surgical procedure, your physician will provide instructions for what you need to do to prepare for surgery. Before the actual procedure begins- regardless of whether you are receiving a concomitant or a standalone procedure – the area where the access incision is to be made will be shaved and scrubbed. A general anesthetic will be given, so you will be asleep during the procedure.
If the surgical ablation is to be a part of either coronary artery bypass graft (CABG) or mitral valve procedures, preparations and expectations should be according to those procedures. The ablation procedure will not significantly affect your experience.
Complications & Risks of Surgical Ablation
Every year, more than 12,000 surgical ablation procedures are performed worldwide. Advances in how the surgery is done and how patients are managed have led to a steady decline in complication rates.
There are complications and risks associated with surgical ablation, as there are with any surgery. Complications associated with this procedure may include, but are not limited to: esophageal perforation, coronary artery injuries, and phrenic nerve paralysis.
Using HIFU surgical ablation, in patients treated to date, as much as two years after the procedure there have been no reported procedure or device-related complications or morbidities.
HIFU surgical ablation is often performed concomitantly (at the same time) with other cardiac surgery procedures including valve repair, valve replacement and coronary artery bypass. Patients receiving concomitant procedures should review the complications and risks associated with those procedures.
What to Expect During Surgical Ablation?
In all surgical ablation procedures, an incision is made through which the physician accesses the heart. The size and location of this incision depends upon whether you will be receiving a concomitant procedure or standalone procedure, and upon your surgeon’s technique.
If you are receiving a concomitant procedure, the ablation is usually performed before your valve or bypass procedure takes place. The next steps in the process vary, depending upon what type of surgical ablation you are receiving and whether it will be an on-pump or off-pump procedure.
On-Pump Surgical Ablation
In an on-pump procedure, your heart is stopped, and a system called cardiopulmonary bypass (CPB) is used to take over the function of your heart (cardio) and lungs (pulmonary). With the CPB system, once the heart is stopped, it is filled with a solution and kept still. The CPB pump performs the function of supplying oxygenated blood to the body. In some cases, aortic clamps are also used to restrict blood flow to the area where the surgeon is working. They are removed once the ablation and/or concomitant procedure is completed.
Off-Pump Surgical Ablation
Off-pump surgery differs from on-pump surgery in that the heart is not stopped. During an off-pump procedure, the heart continues to beat, supplying the body with oxygenated blood. Off-pump techniques were developed to reduce risks associated with on-pump procedures.
HIFU Surgical Ablation
High-intensity focused ultrasound (HIFU) surgical ablation allows patients to remain off-pump, eliminating the need for clamping as work is performed on a beating heart. During a typical HIFU surgical ablation procedure, the physician accesses the patient’s heart, and then inserts a band around the left atrium. This band emits HIFU energy into the atria, creating the ablative lesions. Once the band is in place, ablation is completed in less than 10 minutes. A separate wand-like device can also be placed on the outside of the heart to create any additional lesions the surgeon deems necessary.
What to Expect After Surgical Ablation?
If you have received a concomitant procedure, your recovery and hospital stay will likely be determined by that procedure. Patients receiving a stand alone procedure are often able to go home in a few days.
All ablation patients should expect to have some recurrence of their arrhythmia during the first three to six months, especially during the first two weeks. Patients should not anticipate being in stable sinus rhythm until three to six months after their procedures. Most will likely be placed on antiarrhythmic drugs for the initial recuperation period, in order to assist the heart in recovering its normal rhythm. Patients receiving a concomitant procedure may also be placed on anticoagulation medication.
- Why should a patient choose India Cardiac Surgery Consultants for cardiac care?
- India Cardiac Surgery Consultants provide a vast number of high quality cardiac services. The cardiac team includes board-certified cardiologists and cardiac surgeons, specially trained nurses, and registered technologists. The cardiac team at uses the most advanced technologies available to perform the cardiac procedures and has a lower complication rate.
- Why is the EpicorTM HIFU technique considered a safer and more reproducible procedure?
- The Epicor UltraCinchTM and UltraWandTM devices are designed to be placed on the outside of a beating heart. HIFU energy is applied across the wall of the heart to create very precise and complete lines of cardiac tissue ablation. The energy is directed inward, so there is very little risk of ablating anything other than the targeted tissue. For added control and ease, the electronic console delivering and controlling the acoustic energy is fully automated. Because it is technically less difficult and less invasive than other techniques, HIFU technology and the Epicor Cardiac Ablation System have the potential to increase the number of patients who can be treated for this widely prevalent disease.
- Why surgical ablation is performed?
- Abnormal heart rhythms knows as arrhythmias can cause palpitations, fatigue, shortness of breath and most important, stroke. The goal is to restore a regular rhythm to prevent these conditions from occurring.
- How long will I be in the hospital?
- Depending on your particular circumstances, hospital stays are usually one night. Occasionally, patients are suitable for day case treatment.
- When can I return to work?
- Although we advise taking at least 5 days off work we are aware that some patients are returning to work before this. As the procedure is relatively pain free and incisionless, most patients feel they are able to undertake moderate duties after 48 hours.
- What follow-up arrangements will be made?
- You will be seen a few weeks after the procedure where a CT scan is done to assess the results of the treatment. Results of any biopsy will be discussed at this appointment. From this appointment you will then return to the care of your cancer specialist.
- What can I expect as a patient who undergoes this procedure?
- For those patients who are already undergoing a surgical cardiac procedure, the Epicor Cardiac Ablation System will be used prior to the patient being on a cardiopulmonary bypass machine. Less than five minutes will be added to the overall procedure, and patients can expect a high rate of success. Patients receiving a stand alone procedure (no structural heart disease) can expect the same high success rates. The location and size of the incision will vary by physician, but because the therapy is applied from outside the heart it is sometimes possible to have a very small incision. Standalone patients should be able to leave the hospital significantly earlier than those receiving open-heart surgery.
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