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Maze and Mini Maze
Maze surgery for the treatment of atrial fibrillation (AF) can be done as traditional, open-heart surgery or as a minimally invasive procedure.
Maze Ablation Procedure
More than 40,000 patients have had surgical ablation, often called a Maze. It has been proven effective for a wide range of AF patients, even some with chronic AF. It is an open heart surgery during which the surgeon eliminates (ablates) the trouble spots under direct vision. The procedure is performed primarily in patients with atrial fibrillation who are undergoing open-heart surgery for other reasons, such as bypass or valve surgery, and usually after they have had poor results from medications or other types of treatment.
How is it performed?
Maze surgery (also called the Maze procedure) treats atrial fibrillation by creating a maze of new electrical pathways so that electrical impulses can travel easily through the heart. The surgeon will use instruments to identify the faulty electrical sites in the heart that are causing it to beat irregularly and too fast, then an instrument with a heat source will be used to create precise scars, or ablations, on those spots. These scars will block the abnormal electrical impulses which cause AF. This can return the heart to a normal rhythm.
Generally, recovering from maze surgery takes six to eight weeks. Some patients experience atrial fibrillation again within the first three months after surgery. However, this type of atrial fibrillation is generally more responsive to medications prescribed to control abnormal heart rhythms. After three months, only three patients out of a 100 who have had the Maze surgery experience more atrial fibrillation.
Surgeons have recently developed a minimally invasive approach to AF treatment, often called the “Mini Maze.” It is similar to the open chest surgery, except that the surgeon reaches the heart through three small incisions on each side of the chest. As in the open chest procedure, the surgeon uses an energy source to make precise scars, or ablations, on the heart to block the irregular electrical impulses that cause AF. Because the chest does not have to be opened, recovery is much easier and the average hospital stay much shorter.
How is it performed?
The surgeon will access the heart by making the small incisions between the ribs, through which a tiny camera and video-guided instruments are inserted. As with the open heart Maze procedure, the surgeon will identify the faulty areas where abnormal electrical signals are getting through, create precise scars (ablations) to block those signals, and remove or close off the left atrial appendage, where stroke-causing blood clots often form.
Not having to open up the whole chest makes recovery much easier and reduces the average hospital stay to around four days. The Mini Maze procedure has proven to be an effective treatment, offering many more patients the option of ablation therapy without having to undergo major open chest surgery.
What to Expect After a Mini Maze Procedure
Patients often experience short term AF, which is caused by inflammation of the heart tissue that was worked on. This usually stops within a few months. During this time, the patient will be asked to continue taking a blood thinner and other AF medications. The surgeon, cardiologist or family doctor will decide when the patient should decrease or stop taking these medications. Most likely, a heart monitor will be worn for a day or two to ensure that the heart rate is normal.
Making the Decision
The physician will determine if a Mini Maze is the right choice. Risks will be discussed with the patient and the physician will be happy to answer any questions. The patient will have close follow up after the procedure.
The following physicians perform this procedure:
CT Surgery Group
Janerio Aldridge, MD
Hashmat Ashraf, MD
Gary Grosner, MD