FAQ
What is the Convergent Procedure?
The Convergent Procedure is a comprehensive (full maze), bi-atrial lesion pattern that is created epicardially (on the outside surface of the heart) and endocardially (on the inside surface of the heart) while the heart is beating and the patient is off bypass. It is unique because the Convergent Procedure integrates the expertise of arrhythmia specialist in cardiac surgery and in electrophysiology in a single, minimally invasive procedure.
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Is this just another mini-maze?
The answer is a resounding no. A mini-maze, or pulmonary vein isolation (PVI), is primarily a procedure to treat focal, or paroxysmal, patients who do not have structural heart disease, and who represent less than 15% of AF patients. The Convergent Procedure pattern is a comprehensive lesion pattern that treats both the left and the right atria and is modeled after the “cut & sew” maze. As such, the Convergent procedure is a potential solution for chronic AF, those patients with persistent and permanent as well as those with symptomatic paroxysmal atrial fibrillation.
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Why is a new treatment alternative necessary?
It is estimated that over 40% of atrial fibrillation patients have exhausted all existing treatment alternatives. More than 75% of patients are refractory to drugs within five years, and existing PVI techniques are applicable to only a small portion of the AF population. Surgical and catheter PVI ablations combined address less than 1% of the AF population annually. The Convergent procedure was developed to provide a solution for those patients with difficult to treat, chronic AF.
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Can the Convergent Procedure pattern be created in a minimally invasive procedure?
Yes, the Convergent Procedure pattern can be created during a minimally invasive stand-alone procedure. And it is truly minimally invasive. The Chest is never entered because the procedure is done with the 3 small incisions are in the abdomen and with a catheter inserted in a large vessel in the groin. Patients can return to normal activity soon after the procedure, which includes flying and returning to work.
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What is Cardioscopy?
Cardioscopy, sometimes referred to as Paracardioscopy, was developed to provide direct access and visualization of the heart. This enables the surgeon to create an extensive epicardial lesion pattern on a beating heart in a closed-chest, minimally invasive procedure.
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How is access to the heart enabled through Cardioscopy?
The abdomen is insufflated (expanded) with carbon dioxide and laparoscopic instruments (the same kind used in gastric bypass surgery) are used to create a small opening in the diaphragm and pericardium. A cannula is inserted through the diaphragm opening to enable access to the posterior of the heart. A paracardioscope provides visualization as a coagulation device is inserted through the cannula and manipulated against the posterior pericardial surface.
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Why hasn’t the Convergent Procedure been available until now?
Until recently, techniques to access the surface of the beating heart had to be performed in an operating room. Because the Convergent Procedure is performed with small cameras and instruments, the procedure can be performed in a “hybrid” procedure room where cardiac surgeons and electrophysiologists are now able to work together to treat AF.
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Who is the ideal candidate for the Convergent Procedure?
The best candidate for the Convergent Procedure are the patients who are symptomatic and have failed after taking medications to stop their AF.
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Will I be able to stop taking Coumadin?
Perhaps. This decision is only made after careful evaluation and discussions with your Cardiologist.
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How long is the Procedure?
Generally, the procedure lasts for 4.5-5 hours. The procedure is performed while the patient is asleep under anesthesia. During this time, the surgeon and the electrophysiologists create a standard pattern of scar the inside and the outside of the left and right atria. Once completed, the pattern is tested by attempting to cause AF, to make sure the procedure is complete.
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How long will I be in the hospital?
Depends. Most patients are discharged on day 3 or 4 of their stay. Patients that are not local to the area remain in the local area for a week after discharge. Since the chest is not normally opened, flying is not usually an issue in the post-operative period.
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