Preparing for a Maze Surgery
The operation will usually be scheduled at a time that is best for you and your surgeon, except in urgent cases. As the date of your surgery gets closer, be sure to tell your surgeon and cardiologist about any changes in your health. If you have a cold or the flu, this can lead to infections that may affect your recovery. Be aware of fever, chills, coughing, or a runny nose. Tell the doctor if you have any of these symptoms.
Also, remind your cardiologist and surgeon about all of the medicines you are taking, especially any over-the-counter medicines like aspirin or those that might contain aspirin. You should make a list of the medicines and bring it with you to the hospital.
It is always best to get complete instructions from your cardiologist and surgeon about the procedure, but here are some basics you can expect as a Maze surgery patient.
Most patients are admitted to the hospital the day before surgery or, in some cases, on the morning of surgery. The night before surgery, you will be asked to bathe to reduce the amount of germs on your skin. After you are admitted to the hospital, the area to be operated on will be washed, scrubbed with antiseptic, and, if needed, shaved.
A medicine (anesthetic) will make you sleep during the operation. Because anesthesia is safest on an empty stomach, you will be asked not to eat or drink after midnight the night before surgery. If you do eat or drink anything after midnight, it is important that you tell your anesthesiologist and surgeon.
If you smoke, you should stop at least two weeks before your surgery. Smoking before surgery can lead to problems with blood clotting and breathing.
Before surgery, you may have an electrocardiogram (ECG or EKG), blood tests, urine tests, and a chest X-ray to make sure you don't have any infections or changes in your health. You will be given a medication to help you relax before you are taken into the operating room.
You'll be attached to an electrocardiogram machine. This will monitor your heart's rhythm and electrical activity during the procedure. A needle connected to a small tube (an intravenous or IV line) will be inserted into a vein. This will be used to give you anesthesia before and during the operation.
When you are asleep, a tube will be inserted down your windpipe and connected to a respirator. This machine will take over your breathing during the operation. A second tube will be inserted through your nose, down your throat and into your stomach. This keeps liquid and air from collecting in your stomach and helps to assure that you don't wake up feeling sick and bloated. A thin tube called a catheter will be inserted into your bladder to collect any urine produced during the operation.
The cardiovascular surgeon leads the surgical team, which includes other assisting surgeons, an anesthesiologist, and surgical nurses. When the operation begins, the surgeon will make a cut (called an incision). This may be down the center of the chest or to the side depending on the technique used. If down the center, the breastbone is split so that surgeons can see the heart.
A heart-lung machine is used for maze surgery. A perfusion technologist or blood-flow specialist operates the machine. After you are hooked up to the heart-lung machine, your heart is stopped and cooled.
During the surgery, the surgeon makes a number of small incisions in both of the heart's upper chambers. To make the incisions, surgeons can use a sharp surgical knife called a scalpel, a cryoablation device that destroys tissue by freezing it, or a radiofrequency device that destroys tissue using radiofrequency energy (like microwave heat). Some surgeons use both techniques to make the incisions. The incisions are made in a pattern, like a maze, that will direct the heart's electrical impulses straight to the heart's lower chambers. Maze surgery works because after the heart heals, scar tissue forms. Scar tissue cannot carry (conduct) electrical impulses, so the scar tissue that forms around the incisions keeps the electrical impulses on course.
Once surgeons have finished the surgery, your heart is started again and you are taken off of the heart-lung machine. The surgery takes about three hours.
If you have other heart problems such as coronary artery disease or valve diseases as well as atrial fibrillation, other surgeries can be done at the same time as the maze surgery to correct them. Some patients may also receive a pacemaker during the surgery.
You will probably spend one to two days in the Intensive Care Unit and another three to five days in the hospital recovering from the surgery. During this time you will be given medicines called diuretics. These drugs help control any fluid buildup after surgery. You may also need to take aspirin for the first six weeks after surgery to stop any blood clots from forming.
It usually takes about two months to recover from maze surgery. You may have some pain where your chest was opened, and you may feel more tired than usual. You should be able to go back to work in about three months. Most patients are fully recovered within six months of surgery.