Maze Heart Surgery
Maze heart surgery is a complex procedures to treat a type of heart rhythm disorder (atrial fibrillation).
Atrial fibrillation is the most common type of irregular heart rhythm, affecting millions of people in the world. The condition causes painful symptoms and may account for roughly 15 percent of all strokes. Medications can alleviate symptoms in some patients, but they cannot cure the problem
What causes atrial fibrillation?
A variety of conditions can lead to atrial fibrillation. The most common cause of atrial fibrillation is simply aging. The risk of atrial fibrillation increases as we grow older and areas of scarring or fibrosis develop in our atrial tissue as a result of simple wear and tear. Abnormalities of the valves in the heart, most often the mitral valve, also can cause wear and tear and lead to atrial fibrillation. Some specific conditions that can lead to atrial fibrillation, such as thyroid disease, may be treatable with medications alone. Other conditions may be treatable by Washington University cardiologists in the cardiac catheterization laboratory. In a small number of cases, atrial fibrillation appears to be inherited, while the cause is unknown in many cases.
A variety of conditions can lead to atrial fibrillation. The most common cause of atrial fibrillation is simply aging. The risk of atrial fibrillation increases as we grow older and areas of scarring or fibrosis develop in our atrial tissue as a result of simple wear and tear. Abnormalities of the valves in the heart, most often the mitral valve, also can cause wear and tear and lead to atrial fibrillation. Some specific conditions that can lead to atrial fibrillation, such as thyroid disease, may be treatable with medications alone. Other conditions may be treatable by Washington University cardiologists in the cardiac catheterization laboratory. In a small number of cases, atrial fibrillation appears to be inherited, while the cause is unknown in many cases.
Why is atrial fibrillation a problem?
Atrial fibrillation results in: 1) an irregular heartbeat that may be too slow at times, and racing at others, 2) loss of the atrial contraction that normally contributes to filling of the ventricle (the main pumping chamber of the heart) and improves pump performance, and 3) an abnormal flow of blood through the atrium with areas of stagnation (eddies), which increase the risk of stroke.
In a person with a normal heart rhythm, electric signals trigger the synchronized contraction of muscles in the heart’s two upper chambers, the atria. During atrial fibrillation, a chaotic web of electric impulses spreads throughout the atria, causing the chambers to quiver rather than contract in unison.
In maze heart surgery, a heart surgeon creates multiple cuts into the upper part of your heart (atria) in an intricate pattern, or maze. The surgeon then stitches the incisions together to produce scars that serve as barriers, trapping abnormal electric signals in a “maze” of barricades. Because the scars do not carry electrical signals, they interfere with stray electrical impulses that cause atrial fibrillation. Only one path remains intact, guiding impulses to their correct destination. This restores your heart’s regular, coordinated heartbeat.
The Maze procedure has a success rate of more than 90 percent.
Because maze heart surgery is an open heart surgery, doctors usually consider maze surgery only if:
• Drugs haven’t controlled your atrial fibrillation
• Your symptoms interfere with your quality of life
• You’re at high risk for blood clots or stroke
Maze heart surgery may be an option for:
• People of many ages
• People who have other open-heart procedures at the same time, such as atrial septal defect repair, coronary artery bypass surgery, congenital heart disease surgery and mitral valve repair and replacement
• People who previously have had heart surgery
Advantages
Maze heart surgery isn’t an option for everyone, but offers these advantages in those for whom it’s appropriate:
• Corrects atrial fibrillation in many people
• Restores a regular, coordinated heartbeat
• Reduces the need for long-term use of blood-thinning medications for many people
• Lowers the risk of developing blood clots and having a stroke
• Decreases symptoms, such as fainting or near-fainting
Risks and complications
In people who are candidates for maze heart surgery, the surgery’s risks and complications are low.
In some people, atrial fibrillation hides other pre-existing conditions such as sick sinus syndrome or heart block, and these conditions may surface after treatment of atrial fibrillation. If you have these conditions, you may need a pacemaker.
The heart surgeons work with specialists in heart diseases (cardiovascular diseases) and other areas to accurately diagnose and appropriately treat people who may need maze heart surgery. The surgeons we work with have years of experience performing maze heart surgery, including its use as treatment for congenital heart disease.
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The surgeons perform minimally invasive heart surgery, including minimally invasive maze heart surgery, when possible. Surgeons use multiple methods for maze heart surgery, including:
• Cryotherapy, surgeons routinely use a device to freeze heart tissue and create lesions on the atria (cryotherapy) to reduce the incisions made with a scalpel. Scars to block electrical impulses can be created in 60 to 90 seconds, minimizing the time to perform the maze procedure.
• Minimal access catheter maze procedure. Surgeons use a device to heat heart tissue (catheter radiofrequency ablation) and replicate the lines of scar tissue that are created with the open-heart maze heart surgery.