subject: Minimally Invasive Maze Surgery: How The Procedure Is Performed [print this page] Your heartbeat is produced and regulated by a group of cells within your right atrium called the sinoatrial node. This node generates electrical signals that normally spread throughout the surface of your atria before traveling to the atrioventricular node. As these signals traverse the atria, they cause them to contract. This is part of your heart's normal beating mechanism.
Millions of people suffer a type of arrhythmia called atrial fibrillation (Afib). With this condition, the electrical signals are generated outside the sinoatrial node. Rather than traversing the atria in a uniform pattern, they spread erratically. This causes the atria to fibrillate.
If medications have proven ineffective for controlling Afib, doctors will often suggest minimally invasive maze surgery. This is a procedure during which a cardiothoracic surgeon creates a maze of scar tissue across the surface of both atria. Because scar tissue is unable to conduct an electrical current, the signals are guided along a defined path toward the atrioventricular node. Below, we'll briefly explain how the Maze procedure is performed.
Anesthesia And Right Lung Deflation
The first step is to administer general anesthesia. A breathing tube is then inserted down the throat in order to deflate the patient's right lung. This is a significant departure from past variants of the procedure. Early versions of maze surgery required the patient's heart to be stopped and connected to a heart-lung bypass machine. This machine was necessary in order to maintain the circulation of blood and oxygen during the operation. The breathing tube allows the patient to breathe through one of the lungs, thereby making the heart-lung bypass machine unnecessary.
Incisions And Left Lung Deflation
Once the right lung has been deflated, the surgeon makes three (occasionally, four) incisions into the right side of the patient's chest. A thoracoscope equipped with a small camera is inserted through one of the incisions. Other surgical instruments are inserted through the other incisions.
The thoracoscope sends video images back to a monitor. The surgeon watches these images while opening the pericardium and encircling the heart with two catheters. Once this has been accomplished, the right lung is inflated and the surgical instruments are removed.
Three or four incisions are then made into the left side of the patient's chest. The left lung is deflated while the thoracoscope and other instruments are inserted through these incisions. As before, the surgeon cuts the pericardium open to access the heart.
Catheters And Ablation
The two catheters that were used to encircle the heart from the right side of the chest are pulled around to create a loop. This loop helps direct the surgeon's use of the ablation device. Beginning with the left atrium from the base of the pulmonary veins, the ablation device is used to create lesions. These lesions produce scar tissue, which forms the conduction block that guides the electrical signals from the sinoatrial node to the atrioventricular node.
Once the ablation has been completed, the left lung is reinflated. The thoracoscope and surgical instruments are removed, and the incisions are closed. The patient is then moved into the intensive care unit.
Recovery Following The Procedure
Because the Maze procedure is usually performed with minimally invasive techniques, the recovery period is much shorter than would be the case with open heart surgery. The patient will typically stay in the ICU for up to eight hours before being moved to a normal recovery room for the night. In many cases, the patient can be discharged the following day to complete his or her recovery at home. It is not uncommon to return to work within two weeks, though the ablated scar tissue may require months to fully form.
If you suffer from atrial fibrillation, ask your doctor whether minimally invasive maze surgery is a viable form of treatment. Depending on your circumstances, it may represent the most effective strategy for curing Afib.
