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Maze Procedure—Open Surgery

(Cox Maze)

En Español (Spanish Version)

Definition | Reasons for Procedure | Possible Complications | What to Expect | Call Your Doctor

Definition

Maze is a surgical procedure for the heart. A maze-like pattern of incisions is made in the upper chambers of the heart. The chambers are called the atria.

Maze Procedure

MAZE
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Reasons for Procedure

Maze is done to treat atrial fibrillation. Fibrillation is abnormal beating of the heart muscle. It is caused by erratic electrical impulses that travel through the heart muscle. These impulses can cause the chambers to beat too fast. This can decrease blood flow through the heart. Atrial fibrillation can also cause blood clots to form in the heart that can travel to the brain and cause a stroke.

Maze is used to treat severe cases that did not respond to medicine or other procedures. Electrical impulses cannot flow through scar tissue. By creating specific patterns of scar tissue, maze surgery creates a pathway for healthy impulses and blocks erratic impulses.

Possible Complications

Complications are rare, but no procedure is completely free of risk. If you are planning to have this procedure, your doctor will review a list of possible complications, which may include:

  • Infection
  • Bleeding
  • Anesthesia-related problems
  • The need for a permanent pacemaker
  • Kidney or other organ failure
  • Stroke
  • Death

Some factors that may increase the risk of complications include:

  • Pre-existing heart, lung, or kidney conditions
  • Obesity
  • Diabetes
  • Previous chest surgery
  • Use of certain medicines

Be sure to discuss these risks with your doctor before the procedure.

What to Expect

Your doctor may do the following:

  • Physical exam, including blood and urine tests
  • Chest x-ray —makes pictures of structures inside the chest using a small amount of radiation
  • Electrocardiogram (ECG, EKG)—a test that records the heart’s activity by measuring electrical currents through the heart muscle

In the days leading up to the procedure:

  • Talk to your doctor about your medicines, including over-the-counter medicines. You may be asked to stop taking some medicines up to one week before the procedure, like:
    • Anti-inflammatory drugs (eg, aspirin )
    • Blood thinners, such as clopidogrel (Plavix), warfarin (Coumadin), or ticlopidine (Ticlid)
  • Arrange for someone to drive you home from the hospital. Also, have someone help you at home.
  • Eat a light meal the night before. Do not eat or drink anything after midnight.
  • If you smoke, it is best to stop.

General anesthesia will be used. You will be asleep during the surgery. You may also be given a sedative before surgery to help you relax.

After you are asleep, the doctor will cut through the skin and breastbone. The chest cavity will be opened. Next, the heart will be connected to the heart-lung machine. This machine will take over the functions of the heart and lungs during surgery. Once the machine is active, the heart will be stopped.

A series of small cuts will be made in the atria. The cuts will be made in a maze-like pattern to direct the electrical impulses. The incisions will then be closed with sutures. In some cases, a pacemaker may need to be placed.

Once the maze-like pattern has been completed, the heart will be restarted. When the heart is working well, you will be removed from the heart-lung machine. The chest will be closed with wires. Finally, the skin will be closed with sutures.

Your recovery will be monitored in the intensive care unit. Your heart’s activity will be recorded by EKG. Pain medicine will be given to help you rest comfortably.

About three hours

Anesthesia prevents pain during surgery and early recovery. Your chest will be very sore. You may have a pain pump with IV medicine for the first few days. Your doctor will recommend other medicine to help manage soreness later in recovery.

5-7 days

While you are recovering at the hospital, you may receive the following care:

  • Fluids and pain medicine will be given through an IV line. You may be given medicine to help control build up of fluids.
  • Efforts will be made to get you out of bed and walking as soon as possible.
  • You will be asked to do deep breathing and coughing exercises. This will help reduce the risk of fluid build up in your lungs.
  • If a pacemaker was placed, you will be given instruction on its care.

It can take up to six months to fully recover. Be sure to follow your doctor’s instructions, which may include:

  • Rest when needed. At first, it is normal to feel more tired than usual.
  • Walk daily. Activity will help with the healing process.
  • Take the pain medicine as directed. Some pain medicine causes constipation. To prevent this, drink plenty of fluids and eat high-fiber foods.
  • Keep the incision area clean and dry.
  • Limit certain activities (eg, driving, working, doing strenuous exercise) until you have recovered.

Ask your doctor about when it is safe to shower, bathe, or soak in water.

Call Your Doctor

After you leave the hospital, call your doctor if any of the following occurs:

  • Cough or shortness of breath
  • New chest pain
  • Signs of infection, including fever and chills
  • Palpitations or rapid heart rate
  • Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
  • Nausea and/or vomiting that you cannot control with the medicines you were given after surgery, or which persist for more than two days after discharge from the hospital
  • Pain that you cannot control with the medicines you have been given
  • Coughing up blood
  • Headache or feeling faint
  • Inability to urinate
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Pain and/or swelling in your feet, calves, or legs
  • Other worrisome symptoms

Call for medical help or go to the emergency room right away if any of the following occurs:

  • Sudden chest pain
  • Sudden shortness of breath
  • Problems with vision or speaking
  • Numbness or weakness on one side of your body

If you think you have an emergency, call for medical help right away.

RESOURCES:

Heart Rhythm Society

http://www.hrsonline.org/

Society of Thoracic doctors

http://www.sts.org/

CANADIAN RESOURCES:

Canadian Cardiovascular Society

http://www.ccs.ca/home/index_e.aspx/

References:

Maze procedure for treatment of atrial fibrillation. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/mazeprocedure.html. Accessed March 12. Accessed March 12 , 2010.

Maze surgery. Texas Heart institute website. Available at: http://www.texasheartinstitute.org/HIC/Topics/Proced/mazes.cfm. Updated August 2009. Accessed March 12, 2010

Patient information: the maze procedure. Society of Thoracic Surgeons website. Available at: http://www.sts.org/doc/4511. Updated June 2000. Accessed March 3. Updated June 2000. Accessed March 3 , 2010.

A patient’s guide to heart surgery. University of Southern California, Cardiothoracic Surgery website. Available at: http://www.cts.usc.edu/hpg-index.html. March 12, 2010.

Wood D. Atrial fibrillation. EBSCO Health Library website. Available at: http://www.ebscohost.com/healthLibrary/. Updated September 2009. Accessed March 12, 2010.

Last reviewed June 2013 by Michael J. Fucci, DO

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.


 
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