Robotic Maze Surgery Vs. Ablation October 17, 2023 09:21PM |
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Re: Robotic Maze Surgery Vs. Ablation October 17, 2023 09:45PM |
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Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 12:10AM |
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Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 12:29AM |
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cornerbax
@Daisy (Susan) thank you that is great information. In the scenario you mentioned would I need
a watchman or similar device implanted if I decide to have the LAA closed or is there an LAA
surgery that doesn't need a device implanted?
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 12:38AM |
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Nope, when they clip the LAA from the inside, like they would do during minimally invasive mitral valve repair, this is an alternative to a Watchman—nothing further needed.
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 01:06AM |
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cornerbax
Wow, there are so many different methods it's mind boggling. This is great to know.
You had Afib so did you decide to go through with the LAA closure and Mitral Valve
Repair WITHOUT a Maze procedure like you specified? If so, you did get an ablation
afterwards I assume, right?
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 01:23AM |
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I got a MitraClip, and then had an ablation with Dr. Natale and because of the long history with mitral valve disease, he had to isolate (ablate) the LAA in order to stop the Afib and flutter. This increases stroke risk as it reduces circulation in the LAA, so a few months later he implanted a Watchman. They can’t do it at the same time as the ablation as they have to let the inflammation heal. I don’t know whether after clipping the LAA there could be a scenario where they would need to isolate it in order to terminate Afib/flutter, but Carey would probably know. They don’t actually ablate inside the LAA, but rather the tissue around the mouth of it. I don’t know if that tissue would still be a problem after clipping. And I don’t know if a Maze procedure would address the issue either. Yes, lots of different methods.
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 01:47AM |
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cornerbax
Again, very interesting. I'm just curious why you chose not to go with a Maze procedure at the time of your MitraClip?
The MitraClip I believe doesn't need a Lung Bypass Machine so I'm guessing your surgery wasn't as complex as the
Robotic Mitral Valve Surgery and that may be why you chose not to get a Maze procedure?
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 02:07AM |
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The MitraClip is not surgery, it is a transcatheter procedure with virtually no recovery time—overnight in the hospital just to be cautious then go home. The only recovery is the trivial healing of the femoral vein puncture. Maze is a whole different level as it actually is surgery and requires recovery. There is also a higher incidence of flutter after a Maze than after an ablation.
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 03:33AM |
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cornerbax
I'm curious why you aren't generally a fan of Maze procedures?
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 10:40AM |
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Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 02:24PM |
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cornerbax
Do you think Flutter, should it occur from
This Robotic Maze surgery would be more significant
For me knowing I already have issues with serious flutter
From the Type 1C medications?
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 05:49PM |
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Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 08:09PM |
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Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 08:23PM |
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Daisy
Carey, unanswered question: if your LAA is clipped during a minimally invasive surgical repair of the Mitral Valve, is there tissue left around the mouth of the LAA that could be a source of arrhythmias and need ablation, or is that not a problem? As I understand it, when they ablate/isolate the LAA during an ablation, it is the tissue at the entrance that is ablated, rather than inside the LAA.
Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 10:18PM |
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Re: Robotic Maze Surgery Vs. Ablation October 18, 2023 10:49PM |
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I had mitral valve repair in 2021 with cryo maze procedure and LAA closure.
While my Afib was gone as a result, I soon started getting daily PACs and was put on Met+Flec. I strongly believe the maze procedure, for whatever reason, unleashed my PACs, cause I never had them this severe, daily.
Desperate, I reached out to Natale this yr and had an ablation with him 2 months ago. After 11 days of pure bliss, the PACs came back with a vengeance and tend to make an evening appearance every single day.
Next week it's time to wean off my meds and that'll be interesting to say the least. My prediction is that either the PACs will completely take over 24/7 and I go back to square 1, or perhaps there's a tiny tiny chance that with the meds gone I will actually start feeling better (tiny chance I know, but it has happened to others before).
We shall see....time will tell....
[/quote
This is definitely a huge concern as are the points Carey outlined. I don't want to drag this on forever but it's been an emotional rollercoaster.
Multiple Cardiologists/Ep's never said a word to me about my Mitral Valve Regurgitation after viewing my Echo's and only suggested an Ablation to correct the AFIB. Based on responses on this forum I reached out to Dr. Natale and had a video call with him a few months ago where he said to get my Mitral Valve checked FIRST before considering an Ablation. I am meeting with a Valve Specialist soon and should have remaining questions answered. My current Cardiologist and EP believe my AFIB is being caused from my Mitral Regurgitation, but I still haven't gotten complete certainty on that.
I definitely do NOT want a Valve Repair OR a Maze Procedure if there is a good enough likelihood I will develop regular PAC's and/or Atrial Flutter. I think at this point I need to know what dangers I would have if I did NOT get Mitral Repair Surgery right now and instead, opted for an Ablation. From my understanding there is a chance the Mitral Regurgitation could lessen with a successful Ablation and being back in NSR.
Key points to mention: From my Coronary CT SCAN all of my arteries have 0% Plaque and 0% Calcification. 2 Arteries, the RCA mid and LAD have 25-49% Plaque. I was told this is exceptional as my Calcium score is 0 and all of my arteries look exceptional. Apparently any of the Coronary Arteries would need to be 70% or more clogged to be concerning.
So my Coronary Arteries apparently are great, my Ejection Fraction is 50-52% based on my last 3 Echo's, all other Valves are excellent as is all Chambers of my heart EXCEPT the Left Atria which is severely dilated at 6.5CM. Apparently this is due to the AFIB and/or the Regurgitation.
With all of this said and the only concern is a LOW NORMAL on Ejection Fraction and a 35-50% Mitral Regurgitation, I'm wondering if I shouldn't just get an ablation for the AFIB FIRST, and keep an eye on the Valve after? Carey, what are your thoughts on this?
Anybody else have any suggestions?
Edited 1 time(s). Last edit at 10/19/2023 12:01AM by cornerbax.
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 12:08AM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 12:40AM |
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I would not recommend disregarding Natale's advice. Mitral valve regurgitation trumps PACs and flutter. It probably explains your low-normal EF and improving that will improve everything else. PACs and flutter won't shorten your lifespan, but heart failure sure as hell will and a low-normal EF says you're headed in that direction.
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 12:55AM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 12:56AM |
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cornerbax
With that said, and with a relatively stable EF the last year, what other areas of my Echo could reflect
potential heart failure?
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 12:58AM |
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cornerbax
I’m wondering if I shouldn't just get an ablation for the AFIB FIRST, and keep an eye on the Valve after? Carey, what are your thoughts on this?
Anybody else have any suggestions?
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 01:11AM |
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cornerbax
The Very last question I have is If I do the Ablation at a different time after the Robotic Mitral Valve Surgery,
should I still have the LAA closed off at the same time as the Mitral Valve surgery, or should that too wait until
later with an Ablation?
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 02:55AM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 03:43AM |
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susan.d
Can I get HF if my upper chambers are beating >200-400 (PM download) although my ventricles are paced at 60? It still sounds like wear and tear and enlargement. I don’t think a heart is meant to take such pounding.
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 03:47AM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 05:45AM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 05:57AM |
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cornerbax
So you are totally indifferent on
Whether to do the Maze while they
are in there vs no Maze and an ablation
Later?
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 04:59PM |
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No, not at all. If a surgeon is going inside my chest, I want them to do everything surgical that needs doing. If I'm going to opt for the Maze, then do it with the valve surgery. Same with the LAA clipping. The ablation can wait for all that stuff because it might not even be needed and it's not surgical.
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 05:38PM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 07:48PM |
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Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 10:24PM |
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cornerbax
Got it, and again thank you. I'm glad you also said the Mitral Regurg trumps AFIB/AFLUTTER, PACs, PVCs, etc.
It definitely puts things in perspective and again makes perfect sense. Thank you!
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 11:35PM |
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My local EP, Dr. Natale and Dr. Trento all said the same thing. When you watch severe regurgitation on an echo, you see why!
Re: Robotic Maze Surgery Vs. Ablation October 19, 2023 11:58PM |
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cornerbax
I know 1 or 2 Doctor's can miss things, but FOUR still absolutely perplexes me. It's really insane.
Re: Robotic Maze Surgery Vs. Ablation October 20, 2023 12:10AM |
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I agree that this is not very encouraging! After a couple of incidents like this, I have learned to try to read my own reports or ask people on the forum for help reading them.
Re: Robotic Maze Surgery Vs. Ablation October 20, 2023 12:25AM |
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Re: Robotic Maze Surgery Vs. Ablation October 20, 2023 12:33AM |
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Ask those 4 docs what an ablation will cost. I doubt they have any idea.
Re: Robotic Maze Surgery Vs. Ablation October 20, 2023 02:51AM |
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cornerbax
WOW! 2 of the 4 Doctor's were far more persistent on the Ablation than the other 2 but
they really all said "just get the ablation." And as mentioned NONE of them said a word
about the Mitral Regurgitation even though from Dr. Natale's professional view it was closer
to 50% Regurgitation. Dr. Natale viewed the same disc (I mailed it to him) that the 4 doctors
did, which is why it makes it even more perplexing.
Re: Robotic Maze Surgery Vs. Ablation October 24, 2023 04:32PM |
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Re: Robotic Maze Surgery Vs. Ablation October 24, 2023 08:59PM |
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Jim, you are saying that an EP is there during the surgery of the Valve, LAA closure, andQuote
He also works in conjunction with an ep, should catheter ablation be needed at a later date.
Re: Robotic Maze Surgery Vs. Ablation October 24, 2023 09:05PM |
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Re: Robotic Maze Surgery Vs. Ablation October 24, 2023 09:37PM |
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cornerbax
is there any way they could tell whether or not
a "HYBRID" procedure may be needed BEFORE the Maze?
Re: Robotic Maze Surgery Vs. Ablation October 25, 2023 01:36AM |
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If you're asking, should a Hybrid be done prior to a MiniMaze as part of a treatment plan, the answer is "No". Even with some similarities, they are two different procedures trying to accomplish the same thing. So, if you're going to do a MiniMaze, there would be no reason to have a Hybrid procedure before. It would be somewhat redundant and counter productive.
If you're asking, which procedure should you try first, it depends who you ask. Both have their advocates. It would be like asking whether rf or cryo is better. Both have their advocates.
Jim