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Objective: The ability to treat atrial fibrillation with stand-alone bilateral pulmonary vein isolation and removal of the left atrial appendage using a thoracoscopic closed chest technique (miniMAZE) is being established. Patients with prior cardiac surgery, obesity, or failing hearts have previously been excluded. This study sought to determine the feasibility of performing the miniMAZE in patients with these conditions.
Methods: Retrospective review of all miniMAZE procedures performed to identify patients who had previous cardiac surgery, body mass index >29m², or additional procedures performed.
Results: MiniMAZE procedures were performed on 120 patients over a 15 month period. Fifteen patients had a BMI >29 m², 5 patients had prior open heart surgery, 2 had simultaneous epicardial lead placement. Obese patients had a mean BMI of 35 m² (range 29-57m²). Previous open heart procedures included a combined mitral/aortic valve replacement, an atrial septal defect closure, and three coronary bypass procedures. Two patients with congestive heart failure underwent the miniMAZE procedure in combination with placement of left ventricular epicardial leads. In all patients the procedure was completed successfully in the closed chest. All patients were seen in follow-up (mean 7 months, range 1-14 months) 21/22 of patients are in sinus rhythm; one patient has intermittent atrial flutter (BMI 57m² ). Both patients in heart failure are biventricular paced without evidence of atrial fibrillation.
Conclusions: Prior open heart surgery and obesity are not contraindications to performing the miniMAZE procedure. The miniMAZE is effective and can be combined with other cardiac procedures.

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