Mini-Maze Surgery for Atrial Fibrillation

What is Mini-Maze Surgery?

If conservative treatment options are unsuccessful in treating your Atrial fibrillation and you are a candidate for the procedure, your surgeon may recommend a surgery called Mini-Maze.

Most atrial fibrillation patients have good results from medication and lifestyle changes. However, some patients are unable to tolerate the side effects of the medications used to treat the condition and others continue to have Atrial fib despite medical intervention.

Mini-Maze is a minimally invasive approach to the original Maze surgery. Maze surgery is open-heart surgery to cure Atrial fibrillation and requires a large chest incision, separation of the ribs, the heart to be stopped, and the patient placed on cardiopulmonary bypass.

Mini-Maze surgery was developed to cure Atrial fib without the need for open-heart surgery and without placing the patient on a cardiopulmonary bypass machine. It is performed through tiny incisions between the ribs with the heart still beating.

The smaller incisions with Mini-Maze surgery mean that fewer tissues are cut resulting in quicker healing and recovery.

Advantages of minimally invasive approach compared to open approach include:

  • Minimize Surgical Dissection
  • Accelerate Recovery
  • Shorten Hospital Stay
  • Decrease Postoperative Pain

Candidates for the Mini-Maze surgery include:

  • No underlying heart disease such as leaky valves, enlarged heart, or previous heart attack
  • Poor response to anti-arrhythmic or rate control medicines
  • Intolerance to Coumadin
  • Not morbidly obese

It is important for you to discuss all options of treatment with your surgeon, as Mini-Maze is just one option currently available for the treatment of Atrial fibrillation.

Mini-Maze surgery is performed by Cardiothoracic surgeons in the operating room with the patient under general anesthesia. The operation usually takes about 2-3 hours.

Prior to the surgery, the patient is placed on the operating table on their side. The incision areas are shaved and scrubbed with antiseptic. You will be given a general anesthetic so you will be asleep and not feel any pain. You will be placed on a ventilator to help you breathe during the surgery.

  • Your surgeon will make three small incisions on the side of the chest between the ribs
  • An endoscope, a special viewing instrument with a camera on the end, is inserted into one of the incisions while tiny surgical instruments are inserted into the other incisions
  • A special clamp is inserted through one of the tiny incisions and advanced to the area where the abnormal electrical signals start, between the pulmonary veins and the left atrium
  • Once in position around the right and left pulmonary veins the clamp is activated creating a short burst of heat energy that cauterizes the tissue in this area creating a lesion. This is referred to as ablation
  • Your surgeon may also ablate other areas such as nerve bundles to block the erratic impulses
  • The lesions from the ablation will form scar tissue that interferes with the abnormal electrical conductivity in the heart associated with Atrial Fib
  • Your surgeon will repeat the above procedures on the other side of the chest
  • Next, the left Atrial appendage, an unnecessary but dangerous structure known to contribute to clot formation, is removed and a special stapler is used to close the tissue. Removal of this appendage diminishes the risk of stroke
  • The endoscope and surgical instruments are withdrawn and the incisions are closed with sutures

Post Operative Guidelines

After Mini-Maze surgery you will be taken to ICU for close observation for up to 24 hours. Usually the breathing tube will have been removed in the operating room and you will be breathing on your own.

You will have chest tubes in place to drain fluid from around the heart and lungs.

You will be hooked up to monitors for nursing staff to evaluate your heart rate and blood pressure.

You will likely be in the hospital about 2-3 days and may be able to return to work in 2-3 weeks.

Common post-operative guidelines following Mini-Maze surgery include the following:

  • You will be given a Spirometer, a device for breathing exercises to keep fluid out of your lungs
  • You will need someone to drive you home after you are released
  • Do not remove the dressing over the puncture sites until instructed to do so. Keep the area clean and dry
  • Your surgeon may give you activity restrictions such as no heavy lifting for a few days to prevent bleeding from reoccurring
  • You may have soreness and bruising around the incision sites
  • Your doctor will restart your blood-thinning medicines for several months to prevent blood clots from forming
  • Your doctor will prescribe anti-arrhythmic medications for several months depending on your situation and your doctor’s preference
  • You may be prescribed Prednisone, an anti-inflammatory steroid medicine, to reduce inflammation after the surgery
  • Diuretics may be prescribed to prevent fluid retention
  • Follow-up visits with your doctor are very important for management and discontinuation of your medications
  • Expect some symptoms of arrhythmia for up to 3-6 months while the scar tissue is forming at the site of ablation

Contact your doctor immediately if you have a fever, chills, redness, bleeding, irregular heart beat, chest pain, shortness of breath, weakness, or dizziness.

Risks & Complications

  • As with any medical procedure there are potential risks involved. The decision to proceed with the procedure is made because the advantages outweigh the potential disadvantages
  • It is important that you are informed of these risks before the procedure takes place

Most patients do not have complications after Mini-Maze surgery; however complications can occur and depend on what type of procedure your doctor performs as well as the patient’s health status. (i.e. obese, diabetic, smoker, etc.)

Complications can be medical (general) or specific to Mini-Maze surgery.

Medical complications include those of the anesthesia and your general well being. Almost any medical condition can occur so this list is not complete. Complications include:

  • Allergic reaction to medications
  • Blood loss requiring transfusion with its low risk of disease transmission
  • Heart attack, strokes, kidney failure, pneumonia, bladder infections
  • Complications from incision site such as infection or nerve damage
  • Serious medical problems can lead to ongoing health concerns, prolonged hospitalization, or rarely death

Specific complications for Mini-Maze surgery include:

  • Blood vessel or heart damage requiring an operation for repair
  • Collapsed lung with need for insertion of chest tube to reverse
  • Vein inflammation (phlebitis)
  • Heart tissue inflammation (Pericarditis)
  • Long term shortness of breath

Risk factors that can increase the chance of complications following Mini-Maze surgery include:

  • Diabetes
  • History of kidney disease
  • Poor cardiac function
  • Extensive heart disease
  • Poor nutrition
  • Smoking
  • Obesity
  • Age (over 75)
  • Alcoholism
  • Chronic Illness
  • Steroid Use

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