The one-two punch
To perform TT maze, a surgeon uses special instruments to make small incisions on the sides of the chest to access the heart, deflates the lungs and opens up the paricardial sac that surrounds the heart. Using an endoscope — a tiny camera attached to a long thin tube — to guide him or her, the surgeon then applies ablation techniques using heat or cold to create a scar pattern on the outside of the heart to disrupt the irregular electrical patterns. No heart-lung machine is necessary. Longoria filed a patent for the procedure in 2008, and it is now used in hospitals across the nation.
“What you want is to create roadblocks and allow the natural impulses to come back,” Longoria said. “The scar tissue that we form creates blocks to these aberrant signals, and they self-terminate by going into the scar tissue.”
If the atrial fibrillation returns, as it did for Richardson, then another step is recommended about three months after the surgery: a nonsurgical procedure called a catheter-based endocardial ablation. Small, flexible catheters are inserted through several veins, usually in the groin, and directed to the areas inside the heart that are not accessible using the TT maze procedure. Electrodes at the ends of three or four catheters stimulate the heart to locate the area that is sending out the abnormal electrical signals. Then the doctor kills the problem-causing heart tissue with extreme heat or cold.
“With this staged hybrid ablation, as we call it, you get the TT maze procedure first, and then about three months later, you come back for the catheter ablation,” Longoria said. “We call it the one-two punch.”
Longoria performed Richardson’s TT maze procedure on July 6, 2020, at Stanford Health Care Tri-Valley. His family drove him to the hospital, but because of the pandemic, they had to wait in their car while a nurse came out to give them updates. He was wheeled into surgery about 7 a.m. In the early afternoon, Longoria came out to the parking lot to announce that the surgery had gone smoothly.
“I had about five or six tubes coming out of me,” Richardson said. “They collapsed both lungs for the surgery. I was pretty beat up afterward.”
That wasn’t quite the end of his atrial fibrillation, though. About seven days after the surgery, he was back at the Modesto hospital for electrical cardioversion. This time, it worked. The same thing happened another week later, and again the treatment worked.
Then, in late summer of that year, he underwent a catheter ablation in Modesto. He has been free of atrial fibrillation ever since.
About two months later, he was able to get off his medications, Richardson said. “As far as my doctor is concerned, my heart is healed. I can’t thank Dr. Longoria and his team enough.”
Richardson lost 25 pounds during his hospitalizations and has since lost another 25, bringing him down to 250 pounds. He’s eating healthier food and drinking less alcohol, he said, and he’s planning to go back to work part-time in a month or two.
“I’ve been getting better and better every day,” he said.