Sarah Lewis, PharmD
What is a maze procedure?
A maze procedure is surgery to treat atrial fibrillation. Atrial fibrillation is a type of heart arrhythmia or abnormal heart rhythm. Atrial fibrillation occurs when the electrical signal that causes your heart to beat travels through the heart muscle in a disorganized manner. This results in a heartbeat that is too fast and irregular. Having atrial fibrillation puts you at risk of stroke and heart failure.
A maze procedure involves making a series of cuts in the heart muscle and sewing them back together. As the cuts heal, your body makes scar tissue that blocks the disorganized electrical signal and irregular heart rhythm. This allows your heart to beat normally.
A maze procedure is major surgery that has risks and potential complications. You may have less invasive treatment options. Consider getting a second opinion about all of your treatment choices before having a maze procedure.
Why is a maze procedure performed?
Your doctor may recommend a maze procedure to treat symptomatic atrial fibrillation. Your doctor may only consider a maze procedure for you if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion.
Your doctor may recommend a maze procedure in the following situations:
You are not able to tolerate medication therapy or medication therapy has not helped your atrial fibrillation.
You are not able to take anticoagulant or blood thinners, such as warfarin (Coumadin).
You have had a stroke or you are at high risk of having a stroke.
Who performs a maze procedure?
Cardiac surgeons and thoracic surgeons perform maze procedures. Cardiac surgeons specialize in the surgical treatment of conditions of the heart and its blood vessels. Thoracic surgeons specialize in the surgical treatment of diseases of the chest, including the blood vessels, heart, lungs and esophagus. Cardiac surgeons and thoracic surgeons may also be known as cardiothoracic surgeons.
How is a maze procedure performed?
Your maze procedure will be performed in a hospital. Your surgeon can use either a traditional open-heart surgery method or a minimally invasive method. A heart-lung machine is necessary for the open-heart method. Your surgical team will stop your heart with medicine and the heart-lung machine will pump blood to the body. When the surgery is complete, your surgeon will take your heart off the machine.
Surgical approaches to a maze procedure
Your surgeon will perform your maze procedure using one of the following approaches:
Minimally invasive surgery involves inserting special instruments and an endoscope through at least two small incisions in the side of your chest. The endoscope is a thin, lighted instrument with a small camera. The camera transmits pictures of the inside of your chest to a video screen. Your surgeon sees the inside of your chest on the screen while performing surgery. Minimally invasive surgery generally involves a faster recovery and less pain than open surgery. This is because it causes less trauma to tissues and organs. Your doctor will make a small incision instead of a larger one used in open surgery. Surgical tools are threaded around muscles and tissues instead of cutting through or displacing them as in open surgery. Your minimally invasive surgery may also include the use of a surgical robot and special imaging technologies (computer-assisted surgery) to assist your doctor in viewing and performing the surgery.
- Open surgery involves making a large incision in the front of your chest and breastbone. Open surgery allows your doctor to directly see and access the surgical area. Open surgery generally involves a longer recovery and more pain than minimally invasive surgery. Open surgery requires a larger incision and more cutting and displacement of muscle and other tissues than minimally invasive surgery. Despite this, open surgery may be a safer or more effective method for certain patients
Your surgeon will advise you on which procedure is best for you and how long you need to stay in the hospital based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different maze procedures and ask why your surgeon will use a particular type for you.
Types of anesthesia
Your surgeon will perform your maze procedure using general anesthesia. General anesthesia is a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the surgery and do not feel any pain.
What to expect the day of your maze procedure
Your surgeon may admit you to the hospital the day before your maze procedure. The day of your surgery, you can expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure you understand and sign the surgical consent form.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member. The surgical team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube may be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgical procedure as they happen.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the procedure and during your recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a maze procedure?
As with all surgeries, a maze procedure involves risks and complications. Complications may become serious and life threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding, which can lead to shock
Blood clot, in particular a deep vein thrombosis that develops in the leg or pelvis. A blood clot can travel to your lungs, heart or brain and cause a pulmonary embolism, heart attack, or stroke.
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a maze procedure
Problems with a maze procedure are not common but include:
Kidney failure and other organ failure
Need for a permanent pacemaker
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery. This may include cardiac rehabilitation.
Informing your doctor if you are nursing or there is any possibility of pregnancy
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my maze procedure?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a maze procedure by:
Answering all questions about your medical history, allergies, and medications. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Following dietary guidelines as directed
Losing excess weight before the surgery through a healthy diet and exercise plan
Not eating or drinking before surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and can help the healing process.
Taking or stopping medications exactly as directed. This may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a maze procedure? Are there any other options for treating my condition? Why is the maze procedure the best option for me?
If you find a problem or another condition during surgery, will you treat it right away or will I need more surgery later?
How long will the surgery take? When can I go home?
What restrictions will I have after the surgery? When can I return to work and other activities?
When will I start cardiac rehabilitation? Where do I go for it?
What kind of assistance will I need at home?
What medications will I need before and after the surgery? How should I take my medications?
How will you treat my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my maze procedure?
Knowing what to expect can help make your road to recovery after a maze procedure as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until your vital signs are stable. Your care team will then move you to an intensive care unit (ICU). ICUs provide 24-hour specialized monitoring and care.
It may take a few hours until the major effects of anesthesia wear off and you are alert. When you wake up, you may have a breathing tube in your mouth and tubes and wires attached to your body. These allow your team to monitor your vital signs, drain bodily fluids, take blood, and give medications and fluids.
You will not be able to talk if you have a breathing tube. However, the care team usually removes it within 24 hours. You may have a sore throat from the breathing tube. This is usually temporary, but tell your care team if you are uncomfortable.
As you recover, you may move to a hospital room outside the ICU. This room will have equipment to monitor your heart rhythm and vital signs. Hospital stays after an open-heart maze procedure range from five to 10 days. A minimally invasive maze procedure requires a stay of two to three days.
Recovery after surgery is a gradual process. Recovery time varies depending on the procedure, type of anesthesia, your general health, your age, and other factors. Your doctor will likely refer you to a cardiac rehabilitation program to help you recover. Full recovery takes eight weeks to three months.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your surgery. Your doctor will treat your pain so you are comfortable and can get the rest you need. Call your doctor if your pain gets worse or changes because it may be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up and cardiac rehabilitation appointments after a maze procedure. Contact your doctor for questions and concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Breathing problems, such as shortness of breath, difficulty breathing, labored breathing, or wheezing
Change in alertness, such as passing out, unresponsiveness, or confusionChest pain, chest tightness, chest pressure, or palpitations
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Unexpected drainage, pus, redness or swelling of your incision
How might a maze procedure affect my everyday life?
A maze procedure can cure atrial fibrillation so you can lead a more active, normal life. A maze procedure is highly effective, but may not help every person who has it. Some people have atrial fibrillation again within three months of surgery. This is usually responsive to medical treatment and subsides as the heart heals. A small percent of people will continue to have atrial fibrillation after three months.
You may continue to feel unusually tired and have soreness at your chest incision for several months after an open-heart maze procedure. Both of these issues should improve as your heart and body heal.
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- Atrial Fibrillation Surgery – Maze Procedure. Society of Thoracic Surgeons. http://www.sts.org/patient-information/arrhythmia-surgery/atrial-fibrillation-surgery
- Electrophysiology: MAZE Procedure. Cedars-Sinai. http://www.cedars-sinai.edu/Patients/Programs-and-Services/Heart-Institute/Treatments/Electrophysiol...
- Maze Surgery. Texas Heart Institute. http://www.texasheartinstitute.org/HIC/Topics/Proced/mazes.cfm
- Surgical Procedures for Atrial Fibrillation. Cleveland Clinic. http://my.clevelandclinic.org/heart/disorders/electric/surgtx.aspx