Dr. Niv Ad Mini Maze high sccess rate

I notice that it is quite infrequent any talk of more invasive approaches to treating afib.

Dr. Niv Ad in Falls Church Virginia seems to be a rockstar of the more invasive mini maze. In most cases he puts you on the bypass machine, which scares me, however it seems the success rate on the first go round is much higher. Is it not worth getting cured the first time and feeling than getting multiple ablations?

I have heard better feedback on Niv Ad then Dr. Sirak of five box fame.

Niv Ad was trained by James Cox which has to be the gold standard.

I am curious if anyone has any feedback, or experience
Regard Michael

Is this arthroscopic? If not, realize that it means your chest is going to be cracked open and ribs cut and then wired closed. Recover time? I think I would rather have two or even three catheter ablations (almost day surgery these days) than get cracked open like that. Have no data on comparison of risk factors, etc., as I have only read about mini maze on this forum.

In the meantime, it seems that my TIKOSYN continues to work albeit as of late I am skipping beats. My Potassium level on last blood tests was 4.2, a little lower than I would like. Up the LS V8. My INR was down at 2........have gone vegetarian with green leafy veg in abundance. Need to talk to doc about Warfarin dosing but our family physician has retired and we are searching for a replacement. It is not an easy task here in Ontario if you seek quality.

Will follow this thread with interest.

Murray L

Murray L

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Tikosyn uptake Dec 2011 500ug b.i.d. NSR since!
Herein lies opinion, not professional advice, which all are well advised to seek.

>chest is going to be cracked open and ribs cut and then wired closed. Recover time?

Wow, that takes me back to when I was mid 20s and had a pleurectomy which involved just that. I was on Morphine for a week and lost a lot of weight - took me 6 mths to feel ok again. I hate to think what that would be like 40 years on. I guess I'd only do it if it was a matter of life or death.

MAJOR added risk factors involved! Just from going on heart lung bypass has real downsides for greater dementia risk, depression and other significant complications. Not to mention the greatly significant body stress, pain and recovery time from cracking it open.

Cox was an old school cardiac surgeon so of course he will prefer that more aggressive approach. Mini-maze has its value, no doubt, but going the whole nine yards and cracking the chest is a last gasp effort in my view.

When you say Dr Niv Ad is a 'rock star' in the AFIB world, I imagine very few people outside of the surgical maze world have ever heard of him. The point being that even the most prolific maze surgeons don't have any where near as many cases under their belt compared to a top catheter ablationist. Thus there is a far smaller data pool with which to evaluate their long term track records as well.

My suggestion, particularly if you have paroxysmal AFIB, is to put all that effort first into finding and hiring the very best catheter ablationist, and only even consider something anywhere near that invasive if you have failed at least two of such ablations with a real ablation star.

Shannon



Edited 1 time(s). Last edit at 04/28/2013 11:56AM by Shannon.

Regarding safety of bypass new study

[www.cbsnews.com]
[www.youtube.com]

Niv Ad does not do a sternotomy. He is not a salesman. He is a surgeon.

Once he gets in and sees what's going on he decides if you need to by on heart lung machine. I guess it is based on the size your atria andother anatomicals factors.

He says that there is much less stress on the lungs by doing it this way and that the recovery is better.

He has no reported deaths . Here is his phone number (703) 280-5858

I mean isn;t kind of strange that we have accepted the fact that we may need multiple ablations up front.

There is no question that the mini maze is more effective, I am just puzzled that so few have gone this route.
I personally can't decide whether to go with Dr. Natale, or get it done once and for all with the mini maze.

Mike,

There is no guarantee that you'll "get it done once and for all" with a mini-maze. You may find our 2008 ablation/maze survey of help in deciding which way to go.

Hans

HI Mike,'

I realize their stats sound great up front, but keep in mind this is from a very much smaller pool of patients and , and while the whole mini maze approach has its assets for sure, don't let anyone kid you that it is a walk in the park. I know now of six people now who have had a mini maze from one various surgeons plus the detailed reports of Five Box here with his good results with Dr Sirak. And while five of them report solid success, which is great but not 100% zero arrhythmia as two have had flutter issues to. That is four out of six reporting no arrhythmia in this admittedly limited anecdotal report. The one thing all of them said was that recovery was pretty brutal and required several months to start feeling anywhere close to normal.

There is no free lunch in this business and yet your odds of very comparable success with Natale with one ablation (if paroxysmal) or two ablations (if persistent or long term paroxysmal) are very much in the same neighborhood, and yet his stats reflect dramatically more ablations also mostly of difficult cases, than all the mini-mazes performed by any top surgeon to-date.

Its quite possible Natale may well have more complex AFIB ablations under his belt (9,000+ and growing) than all the combined mini-mazes performed by all surgeons in the US to date, though I'm not sure about that stat? Even the busiest mini maze surgeons seem to have around 300 to 400 mazes under their belt, to my knowledge, though there may be some with more?

And the point is, in the vast majority of cases, the recovery from two ablations is usually duck soup compared to the intensity and duration from one surgical approach and if you go with a top elite persistent AFIB EP and not an less skilled ablationist your odds for comparable success are very good.

If you have a severe long term persistent case with a large dilated left atrium and have failed one or more ablations already, then by all means you could go for the Niv Ad approach if that appeals to you, but it seems premature and unnecessarily invasive for your first attempt at dealing with this.

For example, I was out taking a nice walk with my wife along the San Francisco bay front all the way from one end of Chrissy Field to the base of the Golden Gate bridge and back (well over a mile and more) just the second morning after my second ablation to isolate my LAA with Dr. N. last August and haven't had a blip of flutter since then.

Best of luck whatever your decision

Shannon

Mike,

I haven't seen any supportive comments about minimaze procedures so far, so let me pitch in my two cents. I do generally agree with what many have said, especially Hans' reminder that nothing is guaranteed.

I had the Wolf variety of the minimaze in August, 2006, after years of daily struggles with highly-symptomatic paroxysmal atrial fib. I have been free of atrial fib since that day, with no relapses even during the (very difficult) recovery period. I have very occasional, short patches of atrial flutter, but probably less than one minute's worth per month or so. All things considered, it is night and day, given the previous state of daily, heavy bouts with atrial fib, flutter, and PACs.

I don't know anything about Dr. Niv Ad or exactly what kind of procedure he does. I especially don't know what is the relevance of the bypass machine, because my understanding is that "minimaze" refers to an ablative procedure that does not require a sternotomy. In my case, the surgeon entered the chest cavity through the ribs on each side, deflating lungs as necessary to reach the heart.

The choice of the minimaze was easy for me because I was willing to do anything to solve the problem. The difference in control that the surgeon/operator has with an external ablation versus an internal catheter ablation is quite significant. The surgeon can see what s/he is doing and the instruments provide all kinds of feedback, including indication of a full-thickness burn and verification of electrical isolation. For these reasons, despite the lack of great evidence and all the debate surrounding it, I am convinced that the external surgical approach provides a much greater chance of success, even when compared to the work of most skilled of the ablation practicioners out there.

That said, the difference in recovery times is also quite significant. Surgeons may use words like "minimally-invasive" but I can attest that there is nothing minimal about the minimaze. I'm a reasonably young and healthy person (42 now) and I have to tell you that this thing knocked me completely down for quite some time. It was a week or two before I had my general mobility back and close to a year before I realized that I was finally feeling somewhat normal again. And the pain... when I woke up after the procedure, the pain was so heavy that I thought if it started hurting any worse, I just wouldn't be able to breathe anymore.

Nonetheless, I have no regrets and I would make the same choice again. It was absolutely worth every second of the aftermath and more. If you want to read more of the story, you can visit this page:

[www.weststreetconsulting.com]

Best of luck on your journey,
Russ