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Maze Surgery
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Electrical impulses in your heart muscle (the myocardium) cause your heart to beat (contract). This electrical signal begins in the sinoatrial (SA) node, located at the top of the heart's upper-right chamber (the right atrium). The SA node is sometimes called the heart's "natural pacemaker." When the SA node releases an electrical impulse, it causes the atria to contract. The signal then passes through the atrioventricular (AV) node. The AV node sends the signal through the muscle fibers of the lower chambers (the ventricles), causing them to contract.

Diagram of the electrical conduction system of the heart.

Any irregularity in your heart's natural rhythm is called an arrhythmia.

Why do I need Maze surgery?

Maze surgery is also called the Maze procedure. Surgeons perform Maze surgery to treat an arrhythmia called chronic atrial fibrillation (AF). AF is a fast, irregular heart rhythm where the upper chambers of the heart contract in an uncoordinated fashion. AF is dangerous because it may cause blood to pool in these chambers. The pooled blood can lead to clumps of blood called blood clots. A stroke can occur if a blood clot travels from the heart and blocks a small artery in the brain.

Maze surgery cures AF by creating a "maze" of new electrical pathways to let electrical impulses travel easily through the heart.

Your cardiologist will recommend Maze surgery if AF cannot be treated with medicines or other treatments.

What to Expect

The operation will be scheduled at a time that is best for you and your surgeon, except in urgent cases. Be sure to tell your surgeon and cardiologist about any changes in your health including symptoms of a cold or the flu. Any infection  may affect your recovery.

Also, review all medications (prescription as well as over-the-counter and supplements) with your cardiologist and surgeon.

Before surgery, you may have to have an electrocardiogram (ECG or EKG) [no link], blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health. 

If you smoke, your doctor will want you to stop at least 2 weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing. 

The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin. A medicine (anesthetic) will make you sleep during the operation. This is called "anesthesia." Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery. If you do eat or drink anything after midnight, it is important that you tell your anesthesiologist and surgeon. 

You will  get complete instructions from your cardiologist and surgeon about the procedure, but here are some basics you can expect as a patient. 

Day of Surgery 

Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery.   

Small metal disks called electrodes will be attached to your chest. These electrodes are connected to an electrocardiogram machine, which will monitor your heart's rhythm and electrical activity. You will receive a local anesthetic to numb the area where a plastic tube (called a line) will be inserted in an artery in your wrist. An intravenous (IV) line will be inserted in your vein. The IV line will give you the anesthesia during the operation. You will be given something to help you relax (a mild tranquilizer) before you are taken into the operating room. 

After you are completely asleep, a tube will be inserted down your windpipe and connected to a machine called a respirator, which will take over your breathing. Another tube will be inserted through your nose and down your throat, into your stomach. This tube will stop liquid and air from collecting in your stomach, so you will not feel sick and bloated when you wake up. A thin tube called a catheter will be inserted into your bladder to collect any urine produced during the operation. 

A heart-lung machine is used for Maze surgery. A perfusion technologist or blood-flow specialist operates the machine. Before you are hooked up to this machine, a blood-thinning medicine called an anticoagulant will be given to prevent your blood from clotting. The surgical team is led by the cardiovascular surgeon and includes other assisting surgeons, an anesthesiologist, and surgical nurses. 

After you are hooked up to the heart-lung machine, your heart is stopped and cooled.

During the surgery, the surgeon makes a number of small incisions in both of the heart's upper chambers. To make the incisions, surgeons can use a sharp surgical knife called a scalpel, a cryoablation device that destroys tissue by freezing it, or a radiofrequency device that destroys tissue using radiofrequency energy (like microwave heat). Some surgeons use a combination of techniques to make the incisions. The incisions are made in a certain pattern, like a maze, that will direct the heart's electrical impulses straight to the heart's lower chambers. Maze surgery works because after the heart heals, scar tissue forms. Scar tissue cannot carry (conduct) electrical impulses, so the scar tissue that forms around the incisions keeps the electrical impulses on course.

Once surgeons have finished the surgery, your heart is started again and you are taken off of the heart-lung machine. The surgery takes about 3 hours.

For patients who have AF along with other heart problems like coronary artery disease or valve disease, the surgeon may combine Maze surgery with other operations that will correct both problems. Some patients may also receive a pacemaker during the surgery.

Recovery Time

You can expect to stay in the hospital for 5 to 7 days or longer, including at least 1 to 2 days in the Intensive Care Unit (ICU).

You will be given medicines called diuretics, which help to control any fluid buildup after surgery. You may also need to take aspirin for the first 6 weeks after surgery to stop any blood clots from forming.

Life After Maze Surgery

It usually takes about 2 months to recover from Maze surgery. You may notice that you have some pain where your chest was opened, and that you feel more tired than usual. This is normal. You should be able to go back to work after about 3 months. Most patients find that they have fully recovered within 6 months of surgery.

See also on this site:Heart Surgery Overview

See on other sites:

The Society of Thoracic Surgeons  
www.sts.org/patient-information/arrhythmia-surgery/atrial-fibrillation-surgery
Atrial Fibrillation Surgery – Maze Procedure
 

Updated August 2014
 
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