Research Updates: Surgical Studies

Dr. A. Marc Gillinov,
Director and PI

Dr. Al Waldo,
Director

The Surgical group of the AFIC grant has sought to develop new and better surgical devices, tools and techniques for improving patient outcomes, both in lone AF patients and in those undergoing concomitant surgical procedures (revascularization, valve repair, etc.). AtriCure, Inc. has been and continues to be a critical partner for numerous surgical- based AFIC investigations, and has ongoing and developing projects with Marc Gillinov at the Cleveland Clinic, with Randall Wolf at the University of Cincinnati, and with Albert Waldo at Case Western Reserve University. Medtronic is a notable emerging AFIC partner. Both AtriCure and Medtronic have important surgical ablation devices in trials and on the market, and AtriCure continues to develop a left atrial appendage occluding device – originally invented at the Cleveland Clinic. In conjunction with Dr. Gillinov's group, the company plans to develop minimally-invasive robotic surgical tools for the Intuitive Surgical daVinci S® robotic system.

Atrial appendage occluding device (AOD): The AOD was invented by Dr. Delos Cosgrove, in conjunction with Dr. Gillinov and other Cleveland Clinic personnel, and is under development and testing by AtriCure. In individuals with AF, blood often pools in the left atrial appendage. This pooling substantially increases the risk of clot formation and consequently stroke. The AOD device acts as a clip to physically isolate (rather than surgically remove) the left atrial appendage, to minimize risk of stroke in individuals with AF. The AOD can be placed over the left atrial appendage during surgical procedures, and techniques for placement during robotic surgery are under development. The first AOD was placed in a human in Europe on September 10, 2007. FDA approval of this occluding device is expected in the spring of 2008.

Epicardial mapping of the electrical activity of the heart: AFIC's Dr. Albert Waldo continues to work with AtriCure and local engineering partners on the development of an epicardial electrical mapping tool – a system designed to individualize and improve the success of surgical ablation procedures. This mapping device, an engineering tour de force, will be used by surgeons to devise more effective techniques for cardiac ablation, and to test the success of ablation procedures. First prototyping should be complete by the end of 2007.

Minimally invasive robotic surgical techniques: Dr. Gillinov has recently undertaken a bold new line of research to develop novel techniques for AF treatment during minimally invasive robotic surgery (MIRS). Over the next year, Dr. Gillinov will be developing surgical techniques (1) to access the epicardial ganglia on the exterior of the heart for stimulation or ablation purposes, (2) to apply AtriCure's AOD for stroke prevention, and (3) to perform epicardial ablations on patients with lone AF, and as part of concomitant procedures (such as AF ablation concomitant with mitral valve repair). For patients suffering from AF, successful development of these techniques will create new treatment options, will minimize recovery times, and will reduce the waiting time for treatment.