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Maze Procedure—Open Surgery

(Cox Maze)

Definition

Maze is a surgical procedure for the heart. Incisions are made through the electrical system of the upper chambers of the heart. The chambers are called the atria.

Maze Procedure

MAZE
Copyright © Nucleus Medical Media, Inc.

Reasons for Procedure    TOP

Maze is done to treat atrial fibrillation. Fibrillation is abnormal beating of the 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 medications or other procedures. Electrical impulses cannot flow through scar tissue. By creating specific patterns of scar tissue, the surgery creates a pathway for healthy impulses and blocks erratic impulses. The scars may look like a maze.

Possible Complications    TOP

Problems from the procedure are rare, but all procedures have some risk. Your doctor will review potential problems, like:

  • Infection
  • Bleeding
  • Anesthesia-related problems
  • The need for a permanent pacemaker
  • Kidney or other organ failure
  • Stroke
  • Death

Before your procedure, talk to your doctor about ways to manage factors that may increase your risk of complications such as:

  • Smoking
  • Drinking
  • Chronic disease such as diabetes or obesity
  • The use of certain medications

What to Expect    TOP

Prior to Procedure

Your doctor may do the following:

  • Physical exam, including blood and urine tests
  • Chest x-ray
  • ECG—to test the electrical activity of the heart

In the days leading up to the procedure:

  • Talk to your doctor about your medications, including over-the-counter medications. You may be asked to stop taking some medications up to one week before the procedure.
  • Arrange for someone to drive you home from the hospital and to help you at home.
  • Eat a light meal the night before. Do not eat or drink anything after midnight.
  • If you smoke, talk to your doctor about how you can successfully quit.

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    TOP

After you are asleep, the doctor will cut through the skin and breastbone. The chest cavity will be opened. Next, the heart will be connected to the heart-lung machine. This machine will take over the functions of the heart and lungs during surgery. Once the machine is active, the heart will be stopped.

A series of small cuts will be made in the atria. The cuts will be made in a pattern to direct the electrical impulses that may look like a maze. The incisions will then be closed with sutures. In some cases, a pacemaker may need to be placed.

Once the maze-like pattern has been completed, the heart will be restarted. When the heart is working well, you will be removed from the heart-lung machine. The chest will be closed with wires. Finally, the skin will be closed with sutures.

Immediately After Procedure    TOP

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

How Long Will It Take?    TOP

About 3 hours

How Much Will It Hurt?    TOP

Anesthesia will prevent pain during surgery. Pain and discomfort after the procedure can be managed with medications.

Average Hospital Stay    TOP

5-7 days

Post-procedure Care    TOP

At the Hospital

While you are recovering at the hospital, you may receive the following care:

  • Fluids and pain medication will be given through an IV line. You may be given medication to help control 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.
  • If a pacemaker was placed, you will be given instruction on its care.

During your stay, the hospital staff will take steps to reduce your chance of infection such as:

  • Washing their hands
  • Wearing gloves or masks
  • Keeping your incisions covered

There are also steps you can take to reduce your chances of infection such as:

  • Washing your hands often and reminding visitors and healthcare providers to do the same
  • Reminding your healthcare providers to wear gloves or masks
  • Not allowing others to touch your incisions

At Home

It can take up to 6 months 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.
  • Keep the incision area clean and dry.
  • Limit certain activities until you have recovered.

Call Your Doctor    TOP

It is important to monitor your recovery. Alert your doctor to any problems. If any of the following occur, call your doctor:

  • 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 the incision site
  • Persistent nausea or vomiting
  • Pain that you cannot control with the medications you were given
  • Coughing up blood
  • Headache or feeling faint
  • Inability to urinate
  • Pain, burning, urgency, frequency of urination, or persistent bleeding in the urine
  • Pain or swelling in your feet, calves, or legs
  • New or unexpected symptoms

Call for emergency medical services 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

If you think you have an emergency, call for emergency medical services right away.

RESOURCES:

American Heart Association
http://www.heart.org/
Heart Rhythm Society
http://www.hrsonline.org/

CANADIAN RESOURCES:

Canadian Heart Rhythm Society
http://www.chrsonline.ca
Heart and Stroke Foundation of Canada
http://www.heartandstroke.ca

References:

Cardiac rhythm disturbances. Society of Thoracic Surgeons website. Available at: https://ctsurgerypatients.org/adult-heart-disease/cardiac-rhythm-disturbances. Updated July 2016. Accessed November 28, 2017.
Maze procedure for treatment of atrial fibrillation. University of Southern California Cardiothoracic Surgery website. Available at:
...(Click grey area to select URL)
Accessed November 28, 2017.
Maze surgery. Texas Heart institute website. Available at:
...(Click grey area to select URL)
Updated August 2016. Accessed November 28, 2017.
Last reviewed November 2017 by EBSCO Medical Review Board Michael J. Fucci, DO, FACC
Last Updated: 12/20/2014

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