Maze surgery

Maze surgery is an open-heart surgery that can be done to eliminate atrial fibrillation (AF) where Maze refers to the series of incisions arranged in a maze like pattern in the atria.

Some facts about Maze surgery:

• Atrial fibrillation (AF) can be corrected by using incisional scars to block abnormal electrical circuits that initiate and perpetuate the abnormal electrical waves of AF.
• An extensive series of full-thickness incisions through the walls of both atria, a vertical incision through the sternum and cardiopulmonary bypass is required for this.
• A pattern of scar tissue called as the maze is created by the doctor in the upper chambers of the heart by applying heat or cold. A scalpel can also be used to make several precise incisions.
• The maze interferes with stray electrical impulses that cause atrial fibrillation as scar tissue doesn't carry electricity.
• The method of Maze surgery is more complex and takes longer time.
• The quality of life of people with atrial fibrillation can be improved by a maze surgery.
• The maze procedure is the preferable for atrial fibrillation treatment if you also need to undergo other heart surgery, such as for coronary artery bypass or valve repair. The maze surgery is done during open-heart surgery in these cases.
• It can also be the preferred treatment for people who are experiencing a recurrence of atrial fibrillation or don't respond to other treatments.

Preparation for Maze surgery:

• Several tests including an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest x-ray may be conducted by your doctor to have an idea about the latest information about your health.
• Your care team will talk with you about how to prepare and what to bring to the hospital if you are scheduled for surgery.
• Make sure to inform your surgeon and cardiologist about any changes in your health including symptoms of a cold or flu or any infection that may affect your recovery.
• All medications that you are taking, prescription as well as over-the-counter and supplements should be reviewed with your cardiologist and surgeon.
• You should stop smoking at least two weeks before your surgery, is you smoke as smoking before surgery can lead to problems with blood clotting and breathing.
• You will be asked to bathe, the night before surgery to reduce the amount of germs on your skin.
• You should not eat or drink after midnight the night before surgery as the anesthesia that will be given just before the surgery to make you sleep during the operation is safest on an empty stomach.

Procedure for Maze surgery:

• The rhythm of your heart and electrical activity is monitored by an electrocardiogram machine, to which mall metal disks called electrodes will be attached. These electrodes are also attached to the chest of the patient.
• A local anesthetic will be given to the area where a line will be inserted in an artery in your wrist to make it numb.
• An intravenous (IV) line will be inserted in your vein which will give you the anesthesia during the operation.
• A  mild tranquilizer is given before you are taken into the operating room to help you relax.
• A tube will be inserted down your windpipe and connected to the respirator, which will take over your breathing.
• Another tube will be inserted through your nose into your stomach to stop liquid and air from collecting in your stomach. This will help prevent bloating when you wake up.
• Any urine produced during the operation can be collected by a thin tube called a catheter which will be inserted into your bladder.
• A heart-lung machine is used for Maze surgery which is operated by a perfusion technologist or blood-flow specialist.
• A blood thinning medicine called an anticoagulant will be given to prevent your blood from clotting before the patient is hooked up to the heart-lung machine.
• Maze surgery will be  led by the cardiovascular surgeon and includes other assisting surgeons, an anesthesiologist and surgical nurses.
• The heart of the patient is stopped and cooled after he/she is hooked up to the heart-lung machine.
• The surgeon makes a number of small incisions in both of the upper chambers of the heart during the surgery.
• A sharp surgical knife called a scalpel can be used by the surgeon to make the incisions. A cryoablation device that destroys tissue by freezing it, or a radiofrequency device that destroys tissue using radiofrequency energy can also be used for this purpose.
• A combination of techniques can also be used by some surgeon to make the incisions.
• The incisions are made in a maze like pattern which will help directing the electrical impulses of heart straight to the lower chambers of the heart.
• Scar tissue are formed after the heart heals. The scar tissue that forms around the incisions keeps the electrical impulses on course as scar tissue cannot conduct electrical impulses.
• The heart of the patient will start again and the heart-lung machine will be removed once the surgery is completed.
• Usually the surgery takes about 3 hours, but it may be longer depending on the heart condition of the patient.
• The surgeon may combine Maze surgery with other operations for or patients who have AF along with other heart problems like coronary artery disease or valve disease, which will correct both problems.
• A pacemaker can also be received by some patient during the surgery.

Recovery Time for Maze surgery:

• The patient is expected to stay at least one to two days in the Intensive Care Unit (ICU) and then for 5 to 7 days or longer in hospital.
• Medicines called diuretics will be given to help control any fluid buildup after surgery.
• You may also be advised to take aspirin for the first 6 weeks after surgery to stop any blood clots from forming.
• Usually, it takes about 2 months to recover from Maze surgery.
• Having some pain where your chest was opened, and feeling more tired than usual is normal.