Maze Heart Surgery

Details of Maze Surgery

Before Surgery

Patients who are good candidates for the maze procedure meet with members of the specialized team who will assist in their care. Patients are instructed how to prepare for the surgery, including information about eating, drinking and taking medications. Patients meet with their cardiologist, heart surgeon, anesthesiologist and nurse clinician and are encouraged to ask questions about the surgery and anything relating to their experience at Mayo Clinic.

In addition:

• An echocardiogram (ultrasound of the heart) is done to evaluate the structure and function of the heart.
• A cardiac catheterization may be done to check for coronary artery disease or other cardiovascular disease that could complicate surgery. It is routinely done for patients over 40 years old.
• Other basic diagnostic tests required before surgery include blood tests, an electrocardiogram and a chest X-ray.

Whether more specialized tests such as an electrophysiology study (EP) are needed is determined for each patient.

During Surgery

Maze procedure surgery takes approximately four hours, but can range of three to five hours.

The heart is stopped for the surgery, and a heart-lung machine oxygenates and circulates the blood throughout the body.

The surgeon places, and then sutures, incisions in both atria to isolate and stop the abnormal electrical impulses from forming and to direct the impulses down a normal pathway.

Once the procedure is completed and the surgical team is satisfied that the heart is beating strongly again, the heart-lung machine is disconnected. The chest incisions are then closed (sutured).

The sternum will knit back together in six to eight weeks and will be just as strong once the healing process is complete.

Immediately Following Surgery

Patients are in the hospital an average of 10-12 days. Much of that time is spent waiting for atrial tissue swelling to decrease and for the heart to establish a stabilized rhythm.

When patients awake from the anesthesia, they are generally groggy and somewhat disoriented. The area of the incisions may be sore. Pain medication is available and patients are encouraged to take it as needed.

Patients are in the cardiac intensive care unit for about two days, and then transferred to a regular hospital unit. Typically, once patients have been moved to the regular unit, they are ambulatory (able to walk) while attached to a small heart monitor. While in the hospital, tests are conducted to assess and monitor the patient's condition.

About a third of patients have short-term atrial fibrillation immediately following surgery due to inflammation (swelling) of the atrial tissue, which is controlled with medications. In about three months, the heart heals and medications can be gradually discontinued.

After Leaving the Hospital

In general, recovery is complete about six to eight weeks after surgery. During recovery, patients are usually given aspirin or coumadin to reduce the risk of blood clot formation.

Full energy levels usually start to return in about three months. Most patients can expect to feel more tired than usual, and their stamina may not yet be completely normal. After six months, most patients are back to normal.

The decision when to assume a full work schedule varies with the individual. For patients with physically demanding jobs, the recovery may take longer than three months.

Many patients have benefited from the structured workout of a cardiac rehabilitation program while recovering from surgery. The program starts with a walking schedule for the first six to eight weeks and progresses to more vigorous, supervised training.

Follow-up Care

Generally, patients return to their local doctor a week after being discharged from the hospital and are examined to ensure that they are healing properly. An appointment with the cardiologist takes place within five weeks of being discharged to check heart rhythm and healing.

The Mayo Clinic staff works with patients, their local doctor and local cardiologist to assist with a full and smooth recovery following surgery.

Complications

The mortality rate for patients undergoing the maze procedure averages about 3 percent, with the largest majority of complications affecting patients age 65 and over and those who have other serious medical conditions prior to surgery.

Immediately following surgery, fluid retention is common. However, fluid management with diuretics for the first six weeks after surgery has been successful in overcoming this condition. Other complications are similar to those with any open heart surgery: bleeding, wound infection, stroke and pneumonia.

In some patients, other pre-existing conditions such as sick sinus syndrome or heart block have been masked by atrial fibrillation. When the atrial fibrillation is corrected, the underlying problem surfaces, and these patients may require a pacemaker.