Open Chest Maze Procedure

WHAT YOU SHOULD KNOW:

Open chest maze procedure is heart surgery done to treat atrial fibrillation. Atrial fibrillation is an irregular and often rapid heartbeat. It is caused by fast random electrical messages to the heart muscle. The maze procedure makes a new heartbeat pathway that is shaped like a maze. The new pathway stops random messages and helps the heart to have a regular beat and normal rate. This procedure decreases your risk of stroke. The open chest maze procedure is usually done when other open heart surgery is needed.

CARE AGREEMENT:

You have the right to help plan your care. Learn about your health condition and how it may be treated. Discuss treatment options with your caregivers to decide what care you want to receive. You always have the right to refuse treatment.

RISKS:

• During or after the procedure you may bleed more than expected and need additional surgery. Your body may hold onto too much fluid, or your kidneys may fail. You may have swelling of the heart or other tissues. Your heart may not work as it should after surgery. You may need a permanent pacemaker. You may continue to have atrial fibrillation for several months after your surgery. You may get a blood clot which can cause pain and swelling. Clots can stop blood from flowing where it needs to go in your body and can be life-threatening. The blood clot can go to your lungs. This can cause chest pain and trouble breathing. A blood clot may go to your brain and cause a stroke.
  
  
• Your symptoms may get worse if you do not have this procedure. You may have a heart attack or stroke which can be life-threatening. Ask your caregiver if you have questions about your condition, your procedure, or these risks.

WHILE YOU ARE HERE:

Before your procedure:

• Informed consent is a legal document that explains the tests, treatments, or procedures that you may need. Informed consent means you understand what will be done and can make decisions about what you want. You give your permission when you sign the consent form. You can have someone sign this form for you if you are not able to sign it. You have the right to understand your medical care in words you know. Before you sign the consent form, understand the risks and benefits of what will be done. Make sure all your questions are answered.
  
  
• Vital signs: Caregivers will check your blood pressure, heart rate, breathing rate, and temperature. They will also ask about your pain. These vital signs give caregivers information about your current health.
  
  
• An IV (intravenous) is a small tube placed in your vein that is used to give you medicine or liquids.
  
  
• Pulse oximeter: A pulse oximeter is a device that measures the amount of oxygen in your blood. A cord with a clip or sticky strip is placed on your finger, ear, or toe. The other end of the cord is hooked to a machine. Never turn the pulse oximeter or alarm off. An alarm will sound if your oxygen level is low or cannot be read.
  
  
• Heart monitor: This is also called an ECG or EKG. Sticky pads placed on your skin record your heart's electrical activity.
  
  
• You will be given medicine before your procedure to help you relax. During your procedure, caregivers will use general anesthesia to keep you asleep and free from pain. Anesthesia is given through an IV or as a gas. You breathe the gas through a mask or a tube that is placed down your throat. This tube may cause you to have a sore throat when you wake up.

During your procedure:

• An incision (cut) is made in the center of your breastbone or in your chest wall. You will be connected to a heart-lung bypass machine that does the work of your heart and lungs during the procedure. Caregivers will work on your heart to make a new pathway for electrical messages.
  
  
• You will be taken off of the heart-lung bypass machine allowing your heart and lungs to work on their own. Caregivers may put wires into your chest that stay there in for a short time after surgery. The wires can be used to improve your heartbeat. The incision in your chest is closed with wire and stitches.

After surgery:

You are taken to the recovery room or an intensive care unit (ICU). Caregivers will watch you very closely. A bandage is used to cover your stitches or staples. This bandage keeps the area clean and dry to help prevent infection. A caregiver may remove the bandage shortly after surgery to check the incision. Do not get out of bed until your caregiver says it is OK. Your family may be allowed to visit you in the ICU for a short visit several times a day.

Waiting area:

This is an area where your family and friends can wait until you are able to have visitors. Ask your visitors to provide a way to reach them if they leave the waiting area.

Oxygen and a ventilator:

You may need extra oxygen when waking up and for a day or two after surgery. Caregivers may leave an endotracheal tube (ET tube) in your throat. Oxygen can be given through the ET tube by a breathing machine called a ventilator. After the ET tube is taken out, you may still need oxygen. The oxygen may be given through a plastic mask over your mouth and nose. Oxygen may also be given through nasal prongs (short, thin tubes in your nose).

Chest tube:

A chest tube is used to remove air, blood, or fluid from around your lungs or heart. Removing fluid lets your lungs fill up with air when you breathe, and helps your heart beat normally. The chest tube is attached to a container to collect the blood or fluid. Call a caregiver right away if the tube comes apart from the container. Let the caregiver know if the tubing gets bent, twisted, or the tape comes loose. You may need more than one chest tube.

Arterial line:

An arterial line is a tube that is placed into an artery (blood vessel), usually in the wrist or groin. The groin is the area where your abdomen meets your upper leg. An arterial line may be used for measuring your blood pressure or for taking blood.

Temporary pacemaker:

This is a device that helps your heart beat at a normal speed and in a regular rhythm. It is connected to the wires that were put into your heart muscle during your surgery. The wires may then be connected to a small pacemaker outside of your body. You may need this pacemaker treatment just for a short time.

Neurologic exam:

This is also called neuro signs, neuro checks, or neuro status. A neurologic exam can show caregivers how well your brain works after your surgery. Caregivers will check how your eyes react to light. They may check how easily you wake up and if you respond to discomfort. Your hand grasp or memory may also be tested.

Deep breathing and coughing:

This is an exercise to help decrease your risk for a lung infection after surgery. It also helps open the airways that lead to your lungs. Do the following:

• Hold a pillow tightly against your incision (cut) to decrease pain. Take a deep breath and hold it for as long as you can. Let the air out and follow with a strong cough. Spit out any mucus you cough up. Repeat the steps 10 times every hour. You may be given an incentive spirometer to help you take deeper breaths.
  
  

Intake and output:

Caregivers will keep track of the amount of liquid you get through your IV and later, how much you drink. They also keep track of how much you urinate and how much fluid comes out of your drainage tubes.

Foley catheter:

This is a tube caregivers put into your bladder to drain your urine into a bag. Keep the bag below your waist. This will help prevent infection and other problems caused by urine flowing back into your bladder. Do not pull on the catheter, because this may cause pain and bleeding, and the catheter could come out. Keep the catheter tubing free of kinks so your urine will flow into the bag. Caregivers will remove the catheter as soon as possible, to help prevent infection.

Medicines:

• Antiarrhythmics: This medicine is given to make your heart beat at a regular rate and rhythm.
  
  
• Diuretics: This medicine is given to decrease edema (excess fluid) that collects in a part of your body, such as your legs. Diuretics can also remove excess fluid from around your heart or lungs and decrease your blood pressure. It is often called water pills. You may urinate more often when you take this medicine.
  
  
• Caregivers will give you medicine to take away or decrease your pain.
  
  
  • Tell your caregivers right away if you feel pressure, burning, or tightness in your chest. Tell caregivers right away if you start sweating, have trouble breathing, or feel discomfort in your arm, back, neck, or jaw. These may be signs that your heart is not getting enough oxygen.
    
    
  • Do not wait until the pain is severe to ask for medicine. The medicine may not work as well if you wait too long to take it. Tell caregivers if your pain does not decrease.
    
    
  • Pain medicine can make you dizzy or sleepy. Do not get out of bed without help.

Preventing blood clots:

Around the time of your surgery or procedure you may need to take medicine to thin your blood. Blood thinning medicine helps prevent blood clots from forming in your veins. This medicine makes it easier for a person to bruise and bleed. You will need regular blood tests while taking this medicine. If you have a bleeding disorder or a history of bleeding or blood clots, tell your caregiver. Talk to your caregiver about all of the medicines that you use. Physical activity helps prevent blood clots. Caregivers will help you be as active as possible after your surgery or procedure.

Activity:

When you are well enough, caregivers will have you start sitting up in bed. You may then progress to sitting in a chair. Caregivers will help you stand up safely and walk around. Movement will help prevent blood clots. You may also be given exercises to do in bed. Do not get out of bed on your own until your caregiver says you can. Sit or lie down right away if you feel weak or dizzy. Then press the call light button to let caregivers know you need help.

Food and drink after surgery:

You will be able to drink liquids and eat certain foods once your stomach function returns after surgery. You may be given ice chips at first. Then you will get liquids such as water, broth, juice, and clear soft drinks. If your stomach does not become upset, you may then be given soft foods, such as ice cream and applesauce. Once you can eat soft foods easily, you may slowly begin to eat solid foods.