The Maze Procedure In Detail

The Maze Procedure In Detail

There are multiple ways in which cardiothoracic surgeons can perform a Maze procedure. Many surgical teams still use a traditional approach - they will open the patient's chest and cut through her sternum in order to gain easy access to her heart. In contrast, a growing number of hospitals are employing minimally invasive techniques to access the patient's heart without the need for going through the sternum. This strategy also precludes stopping the patient's heart, a necessary step with open chest surgery.

Below, we'll provide a detailed overview of the Maze procedure. We'll describe the isolation of the pulmonary veins, planning the maze, the influence of the vena cava and coronary sinus, and closing loose appendages.

Isolating The Pulmonary Veins

The right and left atria need to be isolated from the pulmonary veins. This is done in order to prevent the root cause of the atrial fibrillation from influencing the patient's heart while the surgeon works. The surgical team will isolate the pulmonary veins with a bidirectional clamp.

Planning And Ablating The Route

The next step in the Maze procedure is to plan and ablate the route of the sinus node's electrical impulses. The surgeon will examine the nerve fibers of the autonomic nervous system as they connect to the heart. Abnormal nerve fibers are identified and ablated as the surgeon creates a veritable maze in the atria. By ablating the path, he can produce scar tissue that directs the electrical impulses from the atria and across the atrioventricular node. As a result, the atria are no longer able to fibrillate.

Addressing The Left Atrium

In the event that a patient suffers from a severe case of atrial fibrillation, her left atrium can undergo changes in its structure. If it does, those changes can affect its ability to conduct the electrical impulses produced by the sinus node. That can lead to other stimuli that causes the atrium to fibrillate. The surgeon will try to prevent that by forming a connection between lesions on the lower and upper pulmonary veins and isolating the posterior of the left atrium.

Stapling The Left Atrial Appendage

The left atrial appendage presents a danger of stroke. In fact, when blood clots associated with atrial fibrillation cause stroke, they are nearly always attributed to the left atrial appendage. Because it serves little purpose (other than functioning as a "tank" for the left atrium), the surgeon will often close it off by stapling it.

If the Maze procedure was performed through open chest surgery, the surgeon will close the patient's sternum with surgical wire and stitch her chest. If blood has pooled near the heart, tubes are inserted in order to drain it.

If the patient underwent minimally invasive Maze surgery, the incisions that were made under her ribs and armpit are closed and stitched.

While a Maze operation is serious and the mapping of the incisions is complex, a growing number of surgeons are becoming highly proficient in performing it.