News | 30 September 2020

Treating arteriosclerosis and cardiac arrhythmia in a single operation

New minimally invasive operation benefits patients

Thanks to a new method, patients of Maastricht UMC+ can be treated in one single operation for vascular disorders (arteriosclerosis) and heart arrhythmia. This is done by making just a couple of small incisions in the chest. The patient is spared a second operation and in addition, this form of surgery has a number of other benefits, such as a shorter recovery time and less pain.

Patients who need to have surgery for calcification of the coronary artery at the front of the heart frequently also have atrial fibrillation – the most common form of heart arrhythmia. The opposite can also happen, where a patient comes to hospital for atrial fibrillation and sclerosis of the coronary artery is also diagnosed. Normally, surgeons choose to treat the heart arrhythmia during classic open-heart surgery, or the heart arrhythmia is not treated, although it does cause the patient inconvenience. Depending on the seriousness of the condition, the heart arrhythmia will have to be dealt with at a later time. The new surgical method makes that extra treatment unnecessary and results in a smaller number of side effects.

Cardiothoracic surgeons Patrique Segers and Bart Maesen

Minimally invasive surgery with a robot
These days, the emphasis is on operating in a minimally invasive fashion as much as possible. This means that the chest does not have to be opened completely to reach the heart and the surrounding vessels, but instead a few small incisions suffice. The surgeon can introduce his or her instruments into the body through these incisions and use keyhole surgery to treat the heart arrhythmia through ablation. In ablation, the places on the heart where the arrhythmia originates are burnt away, as it were. The same openings can be used to create a bypass around the narrowed part of the affected artery. With a robot, the operator can reach the coronary artery through a small opening between the ribs and connect it to the clogged artery (the bypass).

"It's an all-in-one treatment," says heart surgeon Bart Maesen of Maastricht UMC+, who carries out the procedure with his colleague, heart surgeon Patrique Segers. "Treating atrial fibrillation is just as important as creating the bypass. In that case, why not do it at the same time, so that the patient is spared an extra operation with all the associated stress? Because we use a minimally invasive technique, the recovery time is relatively short and the patient will experience post-operative pain or other problems for a shorter time than after open-heart surgery. So we solve not just two problems with one action, but several." Each year, an estimated 20 patients at Maastricht UMC+ are considered for this operation. The options for each patient are carefully discussed in a multidisciplinary team of heart surgeons.

The Maastricht specialists described their procedure in a paper in the European Journal of Cardio-Thoracic Surgery earlier this year.