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Overview Procedure Benefits Risks Care at Medicover Frequently Asked Questions

Maze Surgery

The Maze procedure, also called the Cox-Maze procedure, is a minimally invasive treatment for atrial fibrillation (AF). Atrial fibrillation is the most common irregular heart rhythm, and it originates in the atria(upper chambers of the heart). Atrial fibrillation is a fast, irregular heart rhythm where the upper chambers of the heart contract in an uncoordinated fashion. Atrial fibrillation is dangerous because it causes blood to accumulate in these chambers.Blood clots can form as a result of the pooled blood. A stroke can occur when a blood clot travels from the heart to the brain and blocks a small artery.

Maze surgery cures atrial fibrillation by forming a "maze" of new electrical pathways that allow electrical impulses to easily travel through the heart. If medications or other treatments are ineffective, your cardiothoracic vascular surgeon will recommend maze surgery.


Procedure

Before the procedure

  • Inform your cardiothoracic surgeon of any changes in your health, including cold or flu symptoms. Any infection may have an impact on your recovery.
  • Review all your prescriptions, over the counter medications, and supplements with your cardiothoracic surgeon.
  • You must have blood tests, urine tests, a chest x-ray, and an electrocardiogram (ECG) to give the latest information about your health to the surgeon.
  • Stop smoking as soon as possible. Even quitting for just a few days can be beneficial and can help in the healing process.
  • Stop taking medications as directed by the doctor which may include blood thinners.
  • You should not drink or eat anything after midnight, the night before the surgery.

During the procedure

  • During the procedure, small metal discs called electrodes will be attached with sticky patches to the chest. These electrodes are connected to an electrocardiogram machine, which will monitor the rhythm and electrical activity of the heart.
  • A local anesthetic will be administered where a plastic tube called a line will be placed in the wrist to numb the area. In your vein, an intravenous (IV) line will be inserted. The IV line will provide general anesthesia during the operation.
  • After you have fallen asleep completely, a tube will be inserted down your throat and connected to a respirator, which will take over your breathing. Another tube will be inserted into your stomach through your nose and throat. This tube will prevent liquid and air from collecting in your stomach, preventing you from feeling sick and bloated when you wake up. A catheter will be inserted into the bladder to collect any urine produced during the procedure.
  • A heart-lung machine is utilized in the maze surgery and before you are hooked up to this machine, a blood-thinning medication called an anticoagulant will be given to prevent blood clotting.
  • After you are hooked to the heart-lung machine, your heart is stopped and the machine will take over its function.
  • Then during the surgery, the surgeon makes a number of small incisions in the atrial chambers of the heart. Surgeons can make an incision with a scalpel or a cryoablation device that destroys tissues by freezing it or a radiofrequency device that destroys tissue by using radiofrequency energy (similar to microwave heat).
  • Some surgeons use a combination of surgical methods to make the incisions. The incisions are made in a certain pattern like a maze, which will redirect the heart’s electrical impulses straight to the lower chambers of the heart. Maze surgery works because after the heart is healed, scar tissue is formed. Because scar tissue cannot conduct electrical impulses, the scar tissue that forms around incisions keeps the electrical impulses on track.
  • Once surgeons have finished the surgery, you are taken off of the heart-lung machine and your heart is started again. The surgery takes about 3 hours.
  • Patients who are having atrial fibrillation 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.

After the procedure

  • You may have to stayback 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 medications such as 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.
  • It usually takes about 2 months to recover from maze surgery. You may notice some pain where your chest was opened and that you feel more tired than usual. This is normal. After about 3 months, you may be able to return to work. Most patients find that they have fully recovered within 6 months of surgery.

Benefits

  • The Maze procedure has revolutionized care for patients who live with atrial fibrillation and who have significant, frequent AFib symptoms that do not respond to medication or traditional ablation.
  • Atrial fibrillation can lead to pooling of blood in the heart. This increases the risk of forming blood clots. These clots can travel to the brain causing stroke. The maze procedure can help reduce the irregular heart rhythm in your heart and help reduce the risk of blood clots or stroke.
  • Maze is a surgical ablation approach that creates a 3-dimensional maze of incisions to form scar tissue that blocks the abnormal electrical patterns responsible for the arrhythmia (AFib).
  • Maze procedure may restore sinus rhythm, synchronize the atria and ventricles and maintain organized heart beat in few patients.

Risks

Maze surgery carries risks and potential complications as any other surgery which includes:

  • Swelling
  • Infection
  • Pain due to the insertion and removal of the breathing tube
  • Pain in the chest or ribs
  • Complications from the heart lung machine
  • Collapsed lung
  • Complications of anesthesia
  • Inflammation in the heart tissue
  • Damage of blood vessels of heart

Maze Surgery Care at Medicover

Medicover Hospital has the best team of eminent cardiothoracic surgeons to perform complex procedures such as maze procedure, heart surgeries, revascularisation,cardiac transplantation and many others. We employ a multidisciplinary approach, latest equipment to perform surgeries. Our world-class technology offers the patient faster recovery time and advanced care at affordable cost.

Citations

https://www.texasheart.org/heart-health/heart-information-center/topics/maze-surgery/
https://intermountainhealthcare.org/services/heart-care/treatment-and-detection-methods/maze-procedure/
https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/atrial-fibrillation-surgery

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Frequently Asked Questions

1. How does the maze procedure work?

The procedure creates a 3-dimensional maze of incisions to form scar tissue that blocks the abnormal electrical patterns responsible for the arrhythmia. The maze corrects all three problems, i.e., restoring sinus rhythm, synchronizing the atria and ventricles and maintaining an organized heartbeat associated with Atrial fibrillation(AFib) simultaneously.

2. How long does the maze procedure last?

Maze procedure lasts for 3 hours. Sometimes for patients who have other heart problems along with atrial fibrillation, the surgeon combines maze with other operations that will correct both the issues.

3. How effective is the maze procedure?

The maze procedure is usually successful as it corrects atrial fibrillation and prevents stroke in 60%–70% of patients. However, atrial fibrillation can come back. You should maintain follow up appointments with the doctor to monitor your health after maze surgery.

4. Who performs the maze procedure?

Cardiothoracic vascular surgeon performs maze procedure.

5. What is the maze procedure recovery time?

It usually takes about 3-6 weeks to get back to your normal activities. Recovery is faster with the minimally invasive method of maze surgery because smaller incisions are made in the chest.

6. What does maze stand for in cardiac surgery?

A surgical technique known as a maze is used to treat atrial fibrillation. A doctor uses heat or cold to create a maze-like pattern of scar tissue in the upper chambers of the heart. Alternatively, the doctor could use a scalpel to make several small incisions.

7. Is the Maze procedure the same as ablation?

Atrial fibrillation is treated surgically with the maze technique. It is also known as surgical ablation. The surgeon may use tiny incisions, radio waves, freezing, or microwave, or ultrasound energy to create scar tissue.