Billings Clinic Performs First Mini-Maze Surgery in Region Minimally Invasive Procedure Treats Atrial Fibrillation
Minimally Invasive Maze Surgery helps local businessman achieve the quality of life that delivers rewards in life with family and profession.


BILLINGS, MT, December 20, 2008 /24-7PressRelease/ -- On July 19, 2008, C. Scott Needham, MD, a cardiothoracic surgeon at Billings Clinic, performed a new procedure to stabilize abnormal heart rhythm caused by atrial fibrillation. Billings Clinic is the only hospital in Eastern Montana to offer the Mini Maze operation. The procedure called Mini-Maze involves electrical isolation of the pulmonary veins and removal of the left atrial appendage in order to restore normal cardiac rhythm. The surgery uses a minimally invasive technique that requires only a 3 cm incision in the upper chest just below the armpit and two smaller incisions that are less that 1 cm in length on each side of the chest. This procedure reduces the risk of stroke associated with atrial fibrillation and restores the heart to a normal regular heart beat.
Atrial fibrillation is caused by abnormal uncoordinated electrical impulses that stimulate the atria causing an abnormal heart beat. The Mini Maze procedure involves creating a series of barriers to construct a "maze" for the path of normal electrical impulses. The maze is created by ablating tissue that sends the abnormal electrical impulses to the two atria, the upper chambers, of the heart.
At Billings Clinic, a team of doctors that includes cardiologists, cardiac electrophysiologists and cardiovascular surgeons treat atrial fibrillation. Treatment options to restore the heart to normal rhythm are medications (to include coumadin), non-surgical procedures and surgical procedures. Working together, the Billings Clinic physicians determine the best option for each patient.
"Atrial fibrillation is complex and cannot be viewed as a condition that has one simple presentation that requires only one consistent treatment," said Scott Sample, DO, Chair of Billings Clinic Department of Cardiology. "By having a team of doctors from different areas of expertise, we are able to collectively address the specific needs for each patient and the benefits provided by each of our treatment options for atrial fibrillation."
When patients presents with atrial fibrillation they are referred to a cardiologist who will consult with the electrophysiologist and cardiovascular surgeon. In the case of Heiko Kaas, Lynn Otto, MD, electrophysiologist at Billings Clinic, recommended that Mr. Kaas see Dr. Needham about a new surgical option for treatment offered at Billings Clinic.
Heiko Kaas, a Billings business man who owns and runs his own bakery, was assessed and determined to be a perfect candidate for the Mini-Maze procedure. Tired of living with the myriad of problems that accompany atrial fibrillation; Mr. Kaas accepted the surgical option on July 19, 2008. Following an event free operation, Mr. Kaas stayed in the hospital for three days then went home in normal heart rhythm and with a great prognosis. Mr. Kass returned to work one week later and today, Mr. Kaas is back at work feeling healthy and energetic.
"This surgery is the most comprehensive solution available for patients with atrial fibrillation," said Dr. Needham. "Completely attacking all nerves and ganglia that can affect rhythm and creating ablation lines that surrounds the pulmonary veins provides complete blockage of the electrical impulses that cause atrial fibrillation."
Frequently, atrial fibrillation is the result of electrical impulses that originate from ganglia (nerve endings) located adjacent the pulmonary veins. During this procedure the surgeon completely isolates the pulmonary veins at the atrial junction and detects the ganglia that are abnormally stimulating the atria. Ablating these ganglia supports complete blockage of the electrical impulse that can result in atrial fibrillation.
The final component of the procedure is the removal of the left atrial appendage. This extra tissue serves no purpose to the function of the heart and can add significant risk of stroke by providing an area for clot formation. By removing this appendage, the risk of stroke is minimalized and the use of coumadin may be discontinued.
The Mini Maze procedure does not require the opening of the entire chest cavity. Incisions are limited to three small incision sites. Hospital stay is usually 3 to 4 days. The operation takes 3 to 4 hours and does not involve radiation. For the three types of atrial fibrillation, paroxysmal, persistent and permanent, success rates are improved from other forms of therapy. For instance, the Mini Maze surgery has a success rate of 97% for paroxysmal, or intermittent, atrial fibrillation.
Atrial fibrillation is the most common arrhythmia affecting more than 2.2 million people in the United States. Physicians are seeing 160,000 new cases annually with largest increase of atrial fibrillation presenting in our elderly population. Atrial fibrillation increases risk for stroke, heart failure and mortality.

About Billings Clinic
Billings Clinic, a leading community organization and the largest employer in Billings, Montana, is a multi-specialty physician group practice and 270-bed hospital. Billings Clinic has branch clinics in the Heights, West End, Red Lodge, Bozeman, Columbus and Miles City, Montana, and Cody, Wyoming. Billings Clinic employs the providers at Colstrip Medical Center. We have affiliations with Stillwater Hospital in Columbus, Livingston HealthCare in Livingston, Pioneer Medical Center in Big Timber, Daniels Memorial Hospital in Scobey, Beartooth Hospital in Red Lodge, Montana, and North Big Horn Hospital in Lovell, Wyoming. Billings Clinic offers 76 physician specialty outreach clinics in 23 rural and tribal communities across Montana, North Dakota and northern Wyoming.
Billings Clinic is a 'community of physicians' working together in a collegial manner toward the mission of providing outstanding healthcare, education and research in their region and the nation. Billings Clinic is a not-for-profit organization, governed by the community, with physician leadership at all levels.
Billings Clinic Cancer Center is the first Comprehensive Cancer Program in southeastern Montana and northern Wyoming accredited by the Commission on Cancer of the American College of Surgeons. The Center includes medical oncology, radiation oncology and gynecologic oncology, an infusion center, integrative medicine, nutrition and stem cell transplant services. More than 120 patients participated in state-of-the-art clinical research trials as part of their care in the last year, more than anywhere else in Montana.
Billings Clinic has been chosen by The National Cancer Institute (NCI) as one of 10 healthcare organizations in the nation to take part in a three-year pilot phase of the new NCI Community Cancer Centers Program (NCCCP) to help bring state-of-the-art cancer care to patients across the United States. Billings Clinic is the only NCCCP site in Montana, Wyoming, Idaho or North Dakota.
For more information please contact Julie Burton at (406) 657-4628 or jburton1@billingsclinic.org .

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Julie Burton
Billings Clinic
Public Relations Specialist
2800 10th Avenue North
Billings, Montana
USA 59101
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