The MAZE procedure is used to treat atrial fibrillation, a heart rhythm abnormality. In normal heart rhythm (sinus rhythm), the electrical impulses that make the heart muscle contract start in the SA node ("the pacemaker") on the right atrium and move down to the AV node (which makes the atria contract) and then to the ventricles for contraction. In atrial fibrillation, the impulse does not go from the SA node to the AV node evenly and instead localizes in one region at any time. So the atria does not contract evenly and instead "fibrillates." Usually, this can be treated with medications, but surgical management can be used in cases where medications have failed.
Pre-Operative Details:
Your surgeon will give specific instructions before the surgery, including risks (i.e. bleeding, infection, adverse reaction to anesthesia, etc.). Please make sure to contact your insurance company for coverage. You will also meet with the anesthesiologist prior to the surgery to go over your medical history. Please do not eat after midnight the night before your surgery. On the day of surgery, you will arrive at the hospital, get registered, and get changed into a hospital gown. A nurse will then review your chart to make sure there are no problems and then get all the paperwork in order for surgery. The anesthesiologist will then start an IV and you will be taken to the operating room, where the surgeon will verify your name and procedure before any medication is given. Once you are under anesthesia, surgery will begin.
Operative Details:
The surgeon will make a long incision in the breastbone/sternum and expose the heart upon spreading the rib cage apart. Once reaching the heart, the patient is put onto cardiopulmonary bypass, a device that pumps oxygenated blood throughout bypassing the heart and lungs to allow the surgeon to operate on the heart. The surgeon then makes multiple, small incisions on the atria that will disrupt the re-entrant "bad" circuits that disrupt the normal electrical impulse flow. The incisions are then sewn back together as to not allow leakage of blood through the atria. These incisions are made in a precise manner as to create a "maze" to allow only one, correct path for an electrical impulse to travel from the SA node to the AV node. Once the heart is restarted, the cardiopulmonary bypass is removed and the chest is closed using stitches and/or staples.
Post-Operative Details:
After the surgery, you will be taken to the intensive care unit and be monitored. You will likely experience pain and will given pain medication appropriately. You will also have chest tubes to drain excess fluids (including blood) from the chest cavity after surgery. You will be on a respirator to help you breathe until you are able to breath on your own, and you will not be able to speak during this time. It is important to keep the incision areas clean and dry. The length of your hospital stay depends on how quickly you are able to recover and perform some physical activity. If you experience fevers, severe pain, redness/swelling/warmth where the incisions were made, or drainage from the incisions, please let your doctor know immediately. Your surgeon will give specific instructions about recovery time.
