Mini-Maze Procedure—Minimally Invasive Surgery

(Wolf Mini-Maze)

by Pamela Jones, MA

Definition

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

A traditional maze surgery requires the chest to be opened and the heart to be stopped. A mini-maze is done with small incisions and special surgical tools. This often leads to shorter recovery time and lower risk of infection.

Maze Procedure

MAZE
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Reasons for Procedure

Maze is done to cure atrial fibrillation. Fibrillation is abnormal beating of 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    TOP

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 to switch to an open procedure
  • Damage to other organs
  • Stroke
  • Death

Some factors that may increase the risk of complications include:

  • Obesity
  • Diabetes
  • Previous chest surgery
  • Use of certain medicines
Be sure to discuss these risks with your doctor before the procedure.

What to Expect    TOP

Prior to Procedure

Depending on the reason for your surgery, 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)—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.

Anesthesia

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.

Description of the Procedure

Minimally invasive procedure only requires small cuts to be made in the chest wall. Two small incisions will be made along your side. A small camera will be inserted through one of the incisions. The doctor will be able to look at the heart with this camera. A second tool will be used to create small areas of scar tissue. The tip of the tool uses extreme cold or radiowaves to destroy small areas of tissue. This process is called ablation.

Once the chosen areas have been treated, the instruments will be removed. The skin will be closed with stitches or staples.

Immediately After Procedure

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

How Long Will It Take?

About 3-4 hours

How Much Will It Hurt?

Anesthesia prevents pain during surgery. Your doctor will recommend other medicine to help manage soreness later in recovery.

Average Hospital Stay

About 3 days

Post-procedure Care

At the Hospital

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 the 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.

At Home

It can take up to 3-4 weeks 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 can cause constipation. To avoid this problem:
  • Keep the incision area clean and dry.
  • Ask your doctor about when it is safe to shower, bathe, or soak in water.
  • Limit certain activities (eg, driving, working, doing strenuous exercise) until your doctor has agreed it is safe.

Call Your Doctor    TOP

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 an 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
In case of 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
Health Canada
http://www.hc-sc.gc.ca/index_e.html/

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.
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.
Patient information: the maze procedure. Society of Thoracic Surgeons website. Available at: http://www.sts.org/doc/4511. Accessed March 3 . Accessed March 3, 2010.
Treatments for atrial fibrillation. Beth Israel Deaconess Medical Center website. Available at: http://www.bidmc.o... . Accessed March 3, 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 2012 by David N. Smith, MD
Last Updated: 6/4/2012