Introduction
A maze surgical procedure is performed to correct an irregular heartbeat. Using a scalpel or tool that produces heat or cold energy, a surgeon shapes scar tissue into a pattern (maze) in the atria (heart's upper chambers). Electrical impulses are not conducted by scar tissue. Therefore, the maze disrupts electrical signals responsible for atrial fibrillation.
Why Is the Maze Procedure Done?
A doctor may advise the maze process if atrial fibrillation (A-fib) does not get better with medications or other treatments or if it comes back after treatment. The maze technique corrects atrial fibrillation and improves the quality of life for persons with this illness. A maze treatment should be performed concurrently with any other heart surgery, such as a coronary artery bypass graft or valve repair.
What Are the Contraindications for Maze Procedure?
Some groups may not be suitable candidates for the maze treatment. Possible contraindications include:
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Heart surgery history (heart bypass surgery, heart transplant, etc).
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Prior lung operations (cancer removal, lung transplant, etc).
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A-fib signs for more than ten years.
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Left atrial diameter above 6.5 millimeters.
What Are the Potential Dangers of Maze Procedure?
Though it is generally highly safe, certain dangers are associated with the maze treatment, particularly when ablation is used. Nevertheless, studies have shown that this procedure has a 90 % success rate, with 99 % of postoperative patients experiencing no further strokes. These consist of the following:
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A lot of blood loss.
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Infection at the incisional or surgical site.
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Clots of blood (increasing risk of stroke and heart attack).
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Renal failure.
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Creation of more irregular cardiac rhythms.
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A-fib recurrence.
What Is Done Before the Maze Procedure?
If a doctor suggests a maze procedure, there is likely another cardiac condition that needs to be addressed in addition to A-fib.
1. Test - The doctor will send the patient for a pre-surgical evaluation involving several tests to determine whether the person is a strong candidate for surgery. These tests include the following-
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Full physical examination.
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Echocardiogram.
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Holter watches.
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Stress test.
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Cardiac transesophageal echography (TEE).
2. Timing - The maze technique is carried out while the patient is admitted. The surgery takes two to four hours, but patients must remain in the hospital for ten days, including one or two days in the cardiac intensive care unit. Whether a person has open surgery or a mini-thoracotomy will determine how long a patient needs to recover in the hospital.
3. Location - The maze operation is carried out in a hospital's cardiac surgery unit.
4. Dressing - Patients can dress whichever they wish when visiting the hospital but must change into a gown. Jewelry and other valuables should be left at home. Although the room may include a lockable cabinet or bedside table, hospitals normally do not assume liability for lost or stolen belongings.
5. Food and Beverage - Similar to other surgeries requiring general anesthesia (fully unconscious of the body), the patient must fast for eight to twelve hours before the procedure to arrive at the hospital with an empty stomach. The surgery will probably happen in the morning.
6. Medication - Additionally, before the treatment, patients will be advised to cease taking blood-thinning medications like Warfarin or nonsteroidal anti-inflammatory drugs like Ibuprofen. Ensure the surgeon knows any medications a patient use, whether prescribed, over-the-counter, or recreationally, to prevent interactions and surgical problems.
7. What to Pack- To be admitted to the hospital, the patient will provide a form of identification and an insurance card. To survive several days in the hospital, the patient will need enough clothes, medications, and supplies for personal care.
What Is Pre-Surgery Preparation for Maze Procedure?
After completing the hospital registration documents, the patient will be led to the patient's room and given a hospital gown to change into.
After that, the patient will see a nurse or technician who will check that patient has not eaten since midnight, run several preoperative tests (such as blood tests, blood oxygen levels, and blood pressure), and attach electrodes to the patient's chest so that an ECG machine can track patient heartbeat.
The patient will have an intravenous (IV) line inserted into a vein, typically in the arm or the back of the patient's hand.
The anesthesiologist will then enter the room to talk with the patient about any past allergies or possible anesthesia-related issues. After the examination and the patient have been given the all-clear for surgery, the patient will be brought into the operating room on a trolley and given a general anesthetic to put the patient to sleep.
What Happens During the Maze Procedure?
The patient will be intubated (a tube will be put into the patient's throat and a big airway of one lung) and attached to a ventilator to help with breathing once the anesthetic kicks in.
The procedure will start with a sternotomy, which entails making an incision in the middle of the patient's chest, cutting the patient's sternum (breastbone) in half using a special saw, and splitting the bone vertically, so the surgeon has direct access to the patient's heart. This is because most maze procedures are done as open surgeries.
After that, a heart-lung bypass machine will be attached to the patient, taking over the heart's function so the surgeon can operate on the heart. But, first, a pattern of lines will be made in the right atrium using either cryoablation or bipolar radiofrequency by the surgeon utilizing the Cox maze III technique to block errant electrical impulses and maintain their flow through the heart.
The patient's sternum will be closed with sterile surgical wire, and the incision will be stitched when all paths have been scarred. Blood that builds up around the heart may need to be drained using chest tubes.
What Happens After Surgery?
The anesthetic would not go away completely for a few hours. At the same time, patients come naturally after the anesthetic. After the procedure, a person will be sent to an interim room and, subsequently, the intensive care unit (ICU), where the patient will be watched.
Following the Procedure - A person should be prepared to spend one or more days receiving treatment from intensivists and critical care nurses in the ICU. The patient will be assisted to a chair within 12 hours after surgery after the anesthetic wears off and the breathing tube has been removed. Sitting upright is essential for postoperative treatment because it lowers the risk of complications.
The Cox maze method is a very effective treatment for atrial fibrillation. However, over 60 % of patients will experience missed heartbeats or transitory A-Fib in the weeks or months due to swelling and inflammation of the cardiac tissue. In addition, open-heart surgery recovery can take six to eight weeks and necessitate extensive postoperative therapy.
What Is the Follow-up After Maze Procedure?
A person must have a follow-up visit with the surgeon a week after returning home, followed by one with a cardiologist in a month. An individual also likely needs an ECG three, six, and twelve months after surgery, as well as once a year after that.
Conclusion
An intimidating maze operation is one that frequently follows significant heart surgery. However, if patients' quality of life is negatively impacted by atrial fibrillation, the patient may find solace in the fact that the surgery is typically very successful. If atrial fibrillation develops independently, the patient might benefit from changing the patient's existing drugs or a less invasive technique, such as cardiac ablation. Consult the patient's cardiologist to determine the best course of action; if the patient still needs clarification, feel free to get a second opinion. A cardiothoracic surgeon will supervise the maze technique. The anesthesiologist, as well as the nurses and technicians in the operating room, are additional members of the surgical team. Since additional heart surgery is typically conducted concurrently with the maze procedure, a perfusionist may be present to operate a heart-lung bypass machine if necessary.
