Maze Procedure Patient Information

The Maze procedure, also called the Cox-Maze procedure, is a minimally invasive treatment for atrial fibrillation (AF). AF is the most common irregular heart rhythm in the United States, and it originates in the atria, or the heart’s upper chambers. With AF, the electrical signal that normally causes the atria to contract in an orderly fashion circles through the heart muscles in an uncoordinated manner, causing the heart to quiver rapidly. Left untreated, AF can lead to an enlarged heart (cardiomyopathy), heart failure, or stroke.

An anesthesiologist will administer general anesthesia prior to the procedure, often through an intravenous line (IV) in the arm. To access the heart, the surgeon must deflate the right lung. Your left lung, with ventilator assistance, will keep bringing air in and delivering it out to the rest of your body while the procedure is performed.

To begin the procedure, the surgeon will make three small incisions on the right side of the chest. He or she will insert a video camera and several small instruments. Through small, thin tubes called catheters, radiofrequency energy will be applied in the atria muscle in an intricate “maze” pattern. Scars will form when these areas heal and because scars do not carry electrical signals, they interrupt the conduction of abnormal impulses and allow the heart to return to a regular, coordinated beat.

Advantages

Advantages to the Maze procedure include:

• Curing atrial fibrillation without the invasiveness of the standard surgical method (less recovery time and less risk of complications);
• An overall success rate of approximately 90 percent – and post-procedure freedom from stroke of approximately 99 percent;
• Removing the need for medications such as blood thinners; and
• Reducing the risk of stroke and blood clots as well as symptoms such as fainting.

Pre-procedure information

The surgeon will perform a physical examination and review your health history at appointments prior to surgery. At each visit you should bring with you a list of any medications, dietary supplements, or herbs that you take, as well as your medical insurance card. Your physician may advise you to stop taking blood-thinning medications such as warfarin (Coumadin) or nonsteroidal anti-inflammatory drugs such as ibuprofen (Advil) for a number of hours or days before the procedure because these medications may interfere with your treatment and recovery. You may also be asked to refrain from eating or drinking for a number of hours beforehand.

On the day or night before your Maze procedure, you may be instructed to shower with a special antibacterial soap. You should also remove any makeup or jewelry and avoid wearing them on the day of the procedure.

Post-procedure information
After the procedure, you will be taken to either the intensive care unit or to a post-operation room for a day or two. As you recover, your progress will be monitored and some tests – particularly an echocardiogram to examine the size of your atria – may be performed. Tubes and medications will be removed and tapered off as you improve.

Recovery expectations
Following surgery and discharge, you will likely have a series of follow-up appointments. The first one is generally within four weeks of the Maze procedure. Your doctor will check your heart rate and rhythm again to see how the atrial fibrillation has responded. If it is still present, your doctor will schedule further treatment. Try to keep the skin around your incisions clean and dry. Recovery from heart surgery often takes 6 to 8 weeks, but minimally invasive procedures take less time.

Call your doctor immediately if you notice any of the following symptoms:

• Bleeding;
• Heart palpitations or shortness of breath;
• Infection; or
• Pneumonia.