by Scholten A
(Cox Maze)

Definition

Maze is a type of heart surgery. It is done through the upper chambers of the heart. The chambers are called the atria.

Maze Procedure
MAZE
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Reasons for Procedure

Maze is done to treat atrial fibrillation. Fibrillation is abnormal beating of the heart muscle.

Maze is used to treat severe cases that were not helped by medicine and other procedures.

Possible Complications

Problems are rare, but all procedures have some risk. The doctor will go over problems that could happen, such as:

  • Excess bleeding
  • Problems from anesthesia such as wheezing or sore throat
  • Infections
  • Damage to organs or structures
  • The need for a lasting pacemaker
  • Stroke
  • Death

Things that may raise the risk of problems are:

  • Smoking
  • Drinking alcohol
  • Long term diseases such as diabetes or obesity

What to Expect

Prior to Procedure

The surgical team may meet with you to talk about:

  • Anesthesia options
  • Any allergies you may have
  • Current medicines, herbs, and supplements that you take and whether you need to stop taking them before surgery
  • Fasting before surgery, such as avoiding food or drink after midnight the night before
  • Whether you need a ride to and from surgery
  • Specialists you may need to see
  • Tests that will need to be done before surgery

Anesthesia

The doctor will give general anesthesia. You will be asleep.

Description of the Procedure

An incision will be made 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.

Small incisions will be made in the upper chambers of the heart (atria). The incisions may look like a maze. They will direct the electrical impulses. The incisions will be closed with sutures. In some cases, a pacemaker may need to be placed.

Once the maze-like pattern is complete, the heart will be restarted. When the heart is working well, the heart-lung machine will be removed. The chest will be closed with wires. Finally, the skin will be closed with sutures. A bandage will be placed over the site.

How Long Will It Take?

About 3 hours

Will It Hurt?

Medicines will help ease any pain and discomfort.

Average Hospital Stay

5 to 7 days

Post-procedure Care

At the Hospital

After the procedure, the staff may:

  • Give you medicines to control pain or nausea
  • Give you IV fluids

If a pacemaker was placed, you will be given instruction on its care.

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

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

There are also steps you can take to lower your risk of infection such as:

  • Washing your hands often and reminding visitors and staff to do the same
  • Reminding staff to wear gloves or masks
  • Not letting others touch your incisions
At Home

Recovery takes up to 6 months. Certain activities will be limited during this time.

Call Your Doctor

Call your doctor if you are not getting better or you have:

  • Signs of infection, such as fever and chills
  • Fast or pounding heartbeats
  • Redness, swelling, excessive bleeding, or discharge from the incision
  • Lasting nausea or vomiting
  • Pain that you cannot control with the medicine
  • Problems passing urine
  • Pain or swelling in your feet, calves, or legs
  • New or unexpected symptoms

Call for medical help or go to the emergency room right away if you have:

  • Sudden chest pain or problems breathing
  • Problems with vision or speaking
  • Numbness or weakness on one side of your body

If you think you have an emergency, call for medical help 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

Atrial fibrillation. EBSCO DynaMed website. Available at: https://www.dynamed.com/condition/atrial-fibrillation. Accessed July 20, 2021.

Cardiac rhythm disturbances. Society of Thoracic Surgeons website. Available at: https://ctsurgerypatients.org/adult-heart-disease/cardiac-rhythm-disturbances. Accessed July 20, 2021.

García-Villarreal OA. Standardization in maze procedure: a step towards a better future. J Thorac Dis. 2018;10(Suppl 33):S3887-S3889.

Maze procedure for treatment of atrial fibrillation. University of Michigan Health website. Available at: https://www.uofmhealth.org/health-library/tv6752. Accessed July 20, 2021.

Maze surgery. Texas Heart institute website. Available at: https://www.texasheart.org/heart-health/heart-information-center/topics/maze-surgery. Accessed July 20, 2021.

Revision Information