Maze Surgery

A surgical procedure done for treating atrial fibrillation is known as maze surgery or surgical ablation.

Atrial fibrillation is the most common type of arrhythmia (abnormal heart rhythm). It is a rapid, irregular heart rhythm that originates in the atria, which are the top chambers of the heart.
Maze surgery is performed to treat atrial fibrillation only when the lesser invasive options fail to treat the condition.

Know More About Surgery

Purpose: Maze surgery is performed in the following cases:

  • Medications for atrial fibrillation cannot be tolerated, or medications are ineffective for treating atrial fibrillation
  • Inability to take blood-thinning medications like warfarin
  • You are at a high risk of having a stroke (a condition in which the blood supply to the brain is obstructed) or have a history of stroke.

Symptoms: The following symptoms may be seen in case of atrial fibrillation, and may require a maze surgery if other treatment options fail:

  • Palpitations (fast, pounding, or fluttering heartbeat)
  • Chest pain
  • Fatigue
  • Dizziness
  • Lightheadedness
  • Shortness of breath
  • Weakness
  • Decrease in ability to exercise

The following diagnostic tests may be performed before a maze surgery:

  1. Physical examination: The doctor examines the patient physically and looks for signs and symptoms of atrial fibrillation. The patient’s medical history and family history are noted by the doctor.
  2. Blood tests and urine tests: These tests are done to check for medical conditions or infections that may cause atrial fibrillation.
  3. Chest x-ray: It helps in evaluating the condition of the patient’s heart and lungs.
  4. Stress test: This test is performed to record the response of a person while performing certain physical exercises, like walking on a treadmill.
  5. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart.
  6. Holter monitor: This is a kind of portable ECG that is to be worn by the patient for 24 hours. The electrical activity of the heart for 24 hours can be obtained using this device.
  7. Event recorder: This is also a kind of portable ECG used to monitor the activity of the heart over a period of a few weeks to months. Whenever the patient experiences the symptoms of fast heartbeats, a button is pressed to activate the monitor.
  8. Echocardiogram: Sound waves are used in this type of ultrasound to obtain detailed images of the heart in motion.

 

The maze surgery procedure is normally performed under general anesthesia (the patient is unconscious during the procedure).
The maze surgery procedure can be performed in one of the following ways:
1. Mini-maze surgery:

  • Small keyhole incisions or cuts are made by the surgeon in the chest area.
  • An endoscope and certain special surgical instruments are inserted by the surgeon through these incisions.
  • The endoscope helps the surgeon to view the inside of the chest while performing the surgical procedure.
  • Heat energy or cold energy is then used to make scar tissue on the heart.
  • The heart is still beating while performing this procedure.
  • The incisions are then closed by the surgeon by sutures (stitches).
  • The procedure has is less painful and has a rapid recovery compared to open surgery.
  • The procedure can also be performed as robotic-assisted surgery, in which the robotic arms are controlled by the surgeon through a monitor while performing the procedure.

2. Open-heart surgery:

  • When an individual has another heart disease along with atrial fibrillation, the surgeon may perform a maze surgery during open-heart surgery.
  • The surgeon makes a large incision or cut in front of the chest and then separates the breastbone.
  • The patient is connected to a heart-lung bypass machine, which does the work of the heart and lungs during the surgery. The heart is stopped during the procedure.
  • Heat energy or cold energy is used to make scar lines in the right and left atria of the heart (upper chambers of the heart).
  • The heart-lung bypass machine is then removed.
  • The breastbone is wired back together by the surgeon, and the incision is closed using sutures.

The risks associated with a maze surgery are:

  • Bleeding
  • Infection
  • Blood clot formation
  • Allergic reaction to anesthesia
  • Heart attack
  • Kidney failure (waste and fluid buildup in the body due to improper functioning of the kidney)
  • New arrhythmias (irregular heart rhythms)
  • Stroke
  • Requirement of a permanent pacemaker (a device implanted in the body to treat arrhythmias)
  • Death

 

  • It is normal to have some discomfort and soreness after the maze surgery.
  • The doctor may recommend pain-relieving medications to relieve the pain.
  • A breathing tube may be placed in the patient’s throat to help the patient breathe. This tube is usually removed two days after the procedure.
  • A tube may be placed in the chest area for the drainage of extra fluids. This tube is also removed two days after the procedure.
  • The vital parameters of the patient are constantly monitored in the hospital.
  • The patient is taught breathing exercises to help in removing the fluids that get accumulated in the lungs during the procedure.
  • The patient is initially kept on a liquid diet, and gradually progressed to normal food.
  • The patient stays in the hospital for two to three days after a mini-maze surgery, and five to ten days after open-heart surgery.
  • The patient is asked to avoid heavy lifting for some weeks after the surgery.
  • The sutures are removed by the surgeon 7 to 14 days after the surgery.
  • The doctor will give you instructions about medications, diet, exercise, and wound care for quick recovery.
  • Complete recovery after maze surgery may take approximately two to three months.

 

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Maze Surgery

A surgical procedure done for treating atrial fibrillation is known as maze surgery or surgical ablation.

Atrial fibrillation is the most common type of arrhythmia (abnormal heart rhythm). It is a rapid, irregular heart rhythm that originates in the atria, which are the top chambers of the heart.
Maze surgery is performed to treat atrial fibrillation only when the lesser invasive options fail to treat the condition.

Types:
The different types of maze surgery procedures are- 
1. Mini-maze:

  • This is a minimally-invasive procedure.
  • The procedure involves making smaller cuts or incisions through which an endoscope (a thin, long tube with a camera on one end) and other medical instruments are placed by the surgeon to make cuts in the heart muscle.
  • This procedure is performed in patients having no other heart conditions other than atrial fibrillation.

2. Full-maze:

  • This is a type of open-heart surgery.
  • This procedure is generally performed when a person needs open-heart surgery for another heart condition.

3. Hybrid maze:

  • A mini-maze procedure combined with a catheter ablation (a minimally-invasive procedure in which heat, cold, or laser energy is used for the treatment of irregular heart rhythms or heart arrhythmias) procedure is known as a hybrid maze.
  • Maze surgery treats the outside of the heart, while catheter ablation treats the inside of the heart.

Symptoms

Purpose: Maze surgery is performed in the following cases:

  • Medications for atrial fibrillation cannot be tolerated, or medications are ineffective for treating atrial fibrillation
  • Inability to take blood-thinning medications like warfarin
  • You are at a high risk of having a stroke (a condition in which the blood supply to the brain is obstructed) or have a history of stroke.

Symptoms: The following symptoms may be seen in case of atrial fibrillation, and may require a maze surgery if other treatment options fail:

  • Palpitations (fast, pounding, or fluttering heartbeat)
  • Chest pain
  • Fatigue
  • Dizziness
  • Lightheadedness
  • Shortness of breath
  • Weakness
  • Decrease in ability to exercise

Diagnosis

The following diagnostic tests may be performed before a maze surgery:

  1. Physical examination: The doctor examines the patient physically and looks for signs and symptoms of atrial fibrillation. The patient’s medical history and family history are noted by the doctor.
  2. Blood tests and urine tests: These tests are done to check for medical conditions or infections that may cause atrial fibrillation.
  3. Chest x-ray: It helps in evaluating the condition of the patient’s heart and lungs.
  4. Stress test: This test is performed to record the response of a person while performing certain physical exercises, like walking on a treadmill.
  5. Electrocardiogram (ECG): This test helps in measuring the electrical activity of the heart.
  6. Holter monitor: This is a kind of portable ECG that is to be worn by the patient for 24 hours. The electrical activity of the heart for 24 hours can be obtained using this device.
  7. Event recorder: This is also a kind of portable ECG used to monitor the activity of the heart over a period of a few weeks to months. Whenever the patient experiences the symptoms of fast heartbeats, a button is pressed to activate the monitor.
  8. Echocardiogram: Sound waves are used in this type of ultrasound to obtain detailed images of the heart in motion.

 

Treatment

The maze surgery procedure is normally performed under general anesthesia (the patient is unconscious during the procedure).
The maze surgery procedure can be performed in one of the following ways:
1. Mini-maze surgery:

  • Small keyhole incisions or cuts are made by the surgeon in the chest area.
  • An endoscope and certain special surgical instruments are inserted by the surgeon through these incisions.
  • The endoscope helps the surgeon to view the inside of the chest while performing the surgical procedure.
  • Heat energy or cold energy is then used to make scar tissue on the heart.
  • The heart is still beating while performing this procedure.
  • The incisions are then closed by the surgeon by sutures (stitches).
  • The procedure has is less painful and has a rapid recovery compared to open surgery.
  • The procedure can also be performed as robotic-assisted surgery, in which the robotic arms are controlled by the surgeon through a monitor while performing the procedure.

2. Open-heart surgery:

  • When an individual has another heart disease along with atrial fibrillation, the surgeon may perform a maze surgery during open-heart surgery.
  • The surgeon makes a large incision or cut in front of the chest and then separates the breastbone.
  • The patient is connected to a heart-lung bypass machine, which does the work of the heart and lungs during the surgery. The heart is stopped during the procedure.
  • Heat energy or cold energy is used to make scar lines in the right and left atria of the heart (upper chambers of the heart).
  • The heart-lung bypass machine is then removed.
  • The breastbone is wired back together by the surgeon, and the incision is closed using sutures.

Risks

The risks associated with a maze surgery are:

  • Bleeding
  • Infection
  • Blood clot formation
  • Allergic reaction to anesthesia
  • Heart attack
  • Kidney failure (waste and fluid buildup in the body due to improper functioning of the kidney)
  • New arrhythmias (irregular heart rhythms)
  • Stroke
  • Requirement of a permanent pacemaker (a device implanted in the body to treat arrhythmias)
  • Death

 

After Procedure

  • It is normal to have some discomfort and soreness after the maze surgery.
  • The doctor may recommend pain-relieving medications to relieve the pain.
  • A breathing tube may be placed in the patient’s throat to help the patient breathe. This tube is usually removed two days after the procedure.
  • A tube may be placed in the chest area for the drainage of extra fluids. This tube is also removed two days after the procedure.
  • The vital parameters of the patient are constantly monitored in the hospital.
  • The patient is taught breathing exercises to help in removing the fluids that get accumulated in the lungs during the procedure.
  • The patient is initially kept on a liquid diet, and gradually progressed to normal food.
  • The patient stays in the hospital for two to three days after a mini-maze surgery, and five to ten days after open-heart surgery.
  • The patient is asked to avoid heavy lifting for some weeks after the surgery.
  • The sutures are removed by the surgeon 7 to 14 days after the surgery.
  • The doctor will give you instructions about medications, diet, exercise, and wound care for quick recovery.
  • Complete recovery after maze surgery may take approximately two to three months.

 

FAQ Section

1) What is Maze Surgery?

A surgical procedure done for treating atrial fibrillation is known as maze surgery.

 

2) What is Atrial Fibrillation?

Atrial fibrillation is a rapid, irregular heart rhythm that originates in the atria (the top chambers of the heart). It is the most common type of arrhythmia (irregular heart rhythm).

 

3) What are the different types of Maze Surgeries?

The different types of maze surgery procedures include:
1. Mini-maze:
This is a minimally-invasive type of procedure.
This type of procedure is performed in patients having no other heart conditions other than atrial fibrillation.

2. Full-maze:
This is an invasive type of open-heart surgery.
This procedure is usually performed when a person has another heart condition along with atrial fibrillation.

3. Hybrid maze:
A hybrid maze procedure is a combination of a mini-maze procedure and catheter ablation (a procedure involving the use of heat, cold, or laser energy for treating irregular heart rhythms).
Catheter ablation treats the inside of the heart, while maze surgery treats the outside of the heart.

4) Why is Maze Surgery performed?

Maze surgery is performed to treat atrial fibrillation in the following cases:

  • Medications fail to treat the condition
  • Blood-thinning medications cannot be taken by the patient
  • Increased risk of developing a stroke, which is a condition of obstructed blood flow to the brain

 

5) What are the symptoms of atrial fibrillation?

The following symptoms may be noticed in a person having atrial fibrillation, which may need a maze surgery if other treatment options fail:

  • Chest pain
  • Palpitations (fast, fluttering heartbeat)
  • Fatigue
  • Dizziness
  • Lightheadedness
  • Weakness
  • Shortness of breath

6) What is the diagnostic procedure before a Maze Surgery?

The following diagnostic tests may be performed before a maze surgery:

  1. Physical examination: The doctor evaluates the physical health stay of the patient, and looks for the symptoms of atrial fibrillation. 
  2. Blood tests and urine tests: These tests are done to check for the presence of any medical disorders or infections that may lead to atrial fibrillation.
  3. Chest x-ray: A chest x-ray helps the doctor to check the condition of the patient’s heart and lungs.
  4. Echocardiogram: Sound waves are used in this test to obtain detailed images of the heart while working.
  5. Stress test: The doctor records the response of a person while performing some physical exercises, like walking on a treadmill.
  6. Electrocardiogram (ECG): This test helps in recording the electrical activity of the heart.
  7. Holter monitor: This is a portable ECG that is to be worn by the patient for 24 hours, during which the electrical activity of the heart is monitored.
  8. Event recorder: This is a portable ECG used for monitoring the activity of the heart over a period of some weeks to months. Whenever the patient experiences the symptoms of fast heartbeats he/she needs to press a button is to activate the monitor.

 

7) How to prepare for a Maze Surgery?

The following preparation may be needed before a maze surgery:

  • Inform your doctor if you have any medical conditions.
  • Inform your doctor if you are on any medications, herbs, or supplements.
  • If you are allergic or sensitive to anything, inform your doctor.
  • Lose any excess weight that you may be having before the surgery by following a healthy diet and exercising.
  • Smoking should be ceased at least two weeks prior to the surgery.
  • You may be told to stop blood-thinning medications like aspirin and warfarin a few days before the procedure.
  • You will be told to not eat or drink anything after midnight the day before the procedure.

 

8) What is the procedure for Maze Surgery?

Maze surgery is usually performed under general anesthesia, in which the patient is kept unconscious during the procedure.
The maze surgery procedure can be performed in one of the following ways:
1. Open-heart surgery:
When the patient has another heart ailment along with atrial fibrillation, the surgeon may do a maze surgery during open-heart surgery.
The surgeon makes a large cut or incision in front of the chest.
The breastbone is separated.
The heart function is stopped during this procedure.
The patient is then connected to a heart-lung bypass machine, which performs the work of the heart and lungs during the surgery. 
The doctor then uses heat energy or cold energy to make scar lines in the right and left atria of the heart, which are the upper chambers of the heart.
The heart-lung bypass machine is removed after the completion of the procedure.
The breastbone is wired back together by the surgeon.
The incision is closed using sutures or stitches.

2. Mini-maze surgery:
The surgeon first makes small keyhole incisions or cuts in the chest area.
An endoscope (a long, thin tube with a camera on one end) and certain special surgical instruments are inserted by the surgeon through these incisions.
The endoscope will help the surgeon to view the inside of the chest while performing the procedure.
Heat energy or cold energy is now used to make scar tissue on the heart.
The heart keeps beating and functioning while performing this procedure.
The incisions are then closed by the surgeon using sutures.
This procedure is less painful and has a rapid recovery than open surgery.
The surgery can also be performed using robotic arms that are controlled by the surgeon. This procedure is known as robotic-assisted surgery.

9) What are the post-procedure steps following a Maze Surgery?

The post-procedure steps for maze surgery include the following:

  • It is normal to have some discomfort and soreness after the maze surgery.
  • The doctor may recommend pain-relieving medications to relieve the pain.
  • A breathing tube may be placed in the patient’s throat to help the patient breathe. This tube is usually removed two days after the procedure.
  • A tube may be placed in the chest area for the drainage of extra fluids. This tube is also removed two days after the procedure.
  • The vital parameters of the patient are constantly monitored in the hospital.
  • The patient is taught breathing exercises to help in removing the fluids that get accumulated in the lungs during the procedure.
  • The patient is initially kept on a liquid diet, and gradually progressed to normal food.
  • The patient stays in the hospital for two to three days after a mini-maze surgery, and five to ten days after open-heart surgery.
  • The patient is asked to avoid heavy lifting for some weeks after the surgery.
  • The sutures are removed by the surgeon 7 to 14 days after the surgery.
  • The doctor will give you instructions about medications, diet, exercise, and wound care for quick recovery.
  • Complete recovery after maze surgery may take approximately two to three months.

 

10) What are the risks associated with Maze Surgery?

The complications associated with a maze surgery are:

  • Bleeding
  • Infection
  • Blood clot formation
  • Allergic reaction to anesthesia
  • Requirement of a permanent pacemaker (an implanted cardiac device that is used to correct arrhythmia)
  • Kidney failure
  • Failure to control the abnormal heart rhythms
  • Other abnormal heart rhythms
  • Heart attack
  • Stroke 
  • Death

 

11) What is the cost of Maze Surgery in India?

The cost of maze surgery varies depending on the type of procedure done, the severity of the condition, and the overall health status of the patient.
The cost also varies amongst different cardiac surgeons in different hospitals. The approximate cost of maze surgery varies between INR 2,50,000 to INR 4,00,000.