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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. Arrhythmias can be divided into two categories: ventricular and supraventricular. Ventricular arrhythmias occur in the heart's two lower chambers, called the ventricles. Supraventricular arrhythmias occur in the atria, which are the heart's two upper chambers.

Arrhythmias are further characterized by the speed of the heartbeats. A very slow heart rate, called bradycardia, means the heart rate is less than 60 beats per minute. Tachycardia is a very fast heart rate, meaning the heart beats faster than 100 beats per minute. Fibrillation, the most serious form of arrhythmia, is fast, uncoordinated beats, which do not pump blood.

Why do I need Maze surgery?

Maze surgery is also called the Maze procedure. Surgeons perform Maze surgery to treat 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 usually be scheduled at a time that is best for you and your surgeon, except in urgent cases. As the date of your surgery gets closer, be sure to tell your surgeon and cardiologist about any changes in your health. If you have a cold or the flu, this can lead to infections that may affect your recovery. Be aware of fever, chills, coughing, or a runny nose. Tell the doctor if you have any of these symptoms.

Also, remind your cardiologist and surgeon about all of the medicines you are taking, especially any over-the-counter medicines such as aspirin or those that might contain aspirin. You should make a list of the medicines and bring it with you to the hospital.

It is always best to get complete instructions from your cardiologist and surgeon about the procedure, but here are some basics you can expect as a Maze surgery patient.

Before the Hospital Stay

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

The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin. After you are admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.

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.

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

Day of Surgery

Before surgery, you may have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray to give your surgeon the latest information about your health. You will be given something to help you relax (a mild tranquilizer) before you are taken into the operating room.

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 a vein. The IV line will be used to give you the anesthesia before and during the operation.

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.

The cardiovascular surgeon leads the surgical team, which includes other assisting surgeons, an anesthesiologist, and surgical nurses. When the operation begins, the surgeon will make a cut (called an incision) down the center of the chest. Then, the breastbone is split so that surgeons can see the heart.

A heart-lung machine is used for Maze surgery. A perfusion technologist or blood-flow specialist operates the machine.

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.

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