Open Chest Maze Procedure

WHAT YOU SHOULD KNOW:

• Open chest maze procedure is an open heart surgery done to treat atrial fibrillation. Atrial fibrillation, also called AF or A-fib, is the most common irregular heart rhythm (beat) problem. Normally, an electrical impulse (stimulus) is triggered by the sino-atrial node in the atria (top chambers of the heart). This impulse travels to the atrium and down the ventricles (lower chambers) in an orderly way. With AF, there are abnormally fast and disorganized impulses stimulating the atria. These impulses begin all together and go in different directions causing irregular, rapid, disordered, and ineffective heartbeats. When your heart beats too fast, you may have problems with the flow of blood in your body. Blood clots may form and cause angina (chest pain), heart attack, or a stroke.
  
  
• During an open chest maze procedure, a maze is created where the electrical impulse will take only one path. This maze is done by making and sewing incisions (cuts) on the left and right atrium to form scar tissue. This scar tissue will stop abnormal electrical signals from stimulating the atrium. Your caregiver may also use freezing substances, or radiowave, microwave, or ultrasound energy to make this scar tissue. Once the abnormal impulses are blocked or redirected, a normal heart rhythm may be restored. With an open chest maze procedure, atrial fibrillation may be treated and quality of life improved.

CARE AGREEMENT:

You have the right to help plan your care. To help with this plan, you must learn about your health condition and how it may be treated. You can then discuss treatment options with your caregivers. Work with them to decide what care may be used to treat you. You always have the right to refuse treatment.

RISKS:

• Your symptoms, such as a fast heartbeat, troubled breathing, getting tired easily, and other heart problems, may worsen without treatment. A greatly reduced blood flow or a formed blood clot may lead to serious and life-threatening conditions. These conditions may include angina (chest pain), heart attack, or a stroke.
  
  
• Problems that may happen after open chest maze procedure include bleeding from the incision, fluid retention, and infection. The wound in the atria may tear or open and cause a large amount of blood loss. During open chest maze procedure, your heartbeat may permanently stop and cause further problems. This may decrease the blood flow further and lead to a heart attack. Other heart surgeries may need to be done. Ask your caregiver if you have questions about your open chest maze procedure.

WHILE YOU ARE HERE:

Before your open chest maze procedure:

• Informed consent: You have the right to understand your health condition in words that you know. You should be told what tests, treatments, or procedures may be done to treat your condition. Your doctor should also tell you about the risks and benefits of each treatment. You may be asked to sign a consent form that gives caregivers permission to do certain tests, treatments, or procedures. If you are unable to give your consent, someone who has permission can sign this form for you. A consent form is a legal piece of paper that tells exactly what will be done to you. Before giving your consent, make sure all your questions have been answered so that you understand what may happen.
  
  
• Vital signs: This includes taking your temperature, blood pressure, pulse (counting your heartbeat), and respirations (counting your breaths). To take your blood pressure, a cuff is put on your arm and tightened. The cuff is attached to a machine which gives your blood pressure reading. Caregivers may listen to your heart and lungs by using a stethoscope. Your vital signs are taken so caregivers can see how you are doing.
  
  
• IV: An IV is a tube placed in your vein for giving medicine or liquids. This tube is capped or connected to tubing and liquid.
  
  
• Pulmonary artery line: A pulmonary artery line, or PA cath, is a kind of central line catheter. It is a thin tube put in a vein near your collarbone, or in your neck or groin. The tube is then guided through your heart and into a blood vessel that goes to your lungs. One end of this catheter is hooked to a machine called a monitor. The monitor shows numbers that tell caregivers how your heart and lungs are doing. The part of this catheter that is inside you may be used to give you medicine. You will need a chest x-ray after the PA line is placed, to be sure the line is where your caregiver wants it. You may have stitches on your skin where the line comes out. This holds the line in place.
  
  
• Foley catheter: A Foley catheter is a tube that is put into your bladder to drain your urine into a bag. The bladder is an organ where urine is kept. Keep the bag of urine well below your waist. Lifting the urine bag higher will make the urine flow back into your bladder, which can cause an infection. Avoid pulling on the catheter because this may cause pain and bleeding, and the catheter may come out. Do not allow the catheter tubing to kink because this will block the flow of urine.
  
  
• Tests: You may need any of the following:
  
  
  • Blood tests: You may need blood taken for tests. The blood can be taken from a blood vessel in your hand, arm, or the bend in your elbow. It is tested to see how your body is doing. It can give your caregivers more information about your health condition. You may need to have blood drawn more than once.
    
    
  • Heart monitor: This is also called an ECG. Sticky pads are placed on different parts of your body. Each pad has a wire that is hooked to a TV-type screen. This shows caregivers a tracing of the electrical activity of your heart.
    
    
  • Transesophageal echocardiogram:
    
    
    • A transesophageal echocardiogram (TEE) is a type of ultrasound that shows pictures of the size and shape of your heart. It also looks at how your heart moves when it is beating. These pictures are seen on a TV-like screen. You may need a TEE if your heart does not show up very well in a regular echocardiogram. You may also need a TEE to check for certain problems such as blood clots or infection inside the heart.
      
      
    • You will be given medicine to relax you during a TEE. Caregivers put a tube in your mouth that is moved down into your esophagus (food pipe). The tube has a small ultrasound sensor on the end. Since your esophagus is right next to your heart, your caregiver can see your heart clearly.
    
    
  • Cardiac catheterization: This is a test to see how well your heart is working. Your arteries (blood vessels) may also be checked to see if they are blocked. A special tube is threaded into your heart through a blood vessel in your leg or arm. Dye may be given so x-ray pictures of your arteries show up better on a TV-like screen.
  
  
• Pre-op care: You may be given medicine right before your procedure or surgery. This medicine may make you feel relaxed and sleepy. You are taken on a stretcher to the room where your procedure or surgery will be done, and then you are moved to a table or bed.
  
  
• General anesthesia: This is medicine that may be given in your IV or as a gas that you breathe. You may wear a face mask or have a tube placed in your mouth and throat. This tube is called an endotracheal tube or ET tube. Usually you are asleep before caregivers put the tube into your throat. The ET tube is usually removed before you wake up. You are completely asleep and free from pain during surgery.

During your open chest maze procedure:

• The hair in your chest and other parts of the body may be shaved if that is needed. Soap and water will be used to clean your chest and sheets will be put over you.
  
  
• During your open chest maze procedure, a large incision will be made in your sternum (breastbone) to expose your heart. You may be connected to a heart-lung bypass machine that will work like your own heart and lungs during the procedure. This will also allow the heart to stop beating so your caregiver can do the procedure on a still heart. Small incisions will be made and sewn in the right and left atria. This will form scar tissue and a maze where the impulses can now travel in one direction. Your caregiver may also use freezing substances, or radiowave, microwave, or ultrasound energy to create this scar tissue.
  
  
• You will then be removed from the heart-lung bypass machine and connected to an external pacemaker. A pacemaker is a machine that helps your heart beat normally and in a regular rhythm. The openings and incisions in your chest are then closed with stitches (threads) or staples. A bandage is placed over your incision to control bleeding.

After your open chest maze procedure: You may be transferred to a recovery room or a cardiac care unit after your open chest maze procedure. Caregivers will watch you closely for problems that can happen after your open chest maze procedure. The catheter inserted for the procedure may be removed and a tight pressure bandage will cover the incision. A caregiver may remove the bandages soon after your surgery to check your wound. Ask your caregiver for more information about ways to prevent bleeding and take care of your incision.

• Activity: You will need to lie flat and still in bed for a few hours. Caregivers will help you roll from side to side. If an artery in your groin was used for the procedure, you must keep your leg straight. Do not bend it until your caregiver tells you it is OK. Your caregiver will also tell you when it is OK to get out of bed. Call your caregiver before getting up for the first time. If you feel weak or dizzy after getting up, sit or lie down right away and call your caregiver.
  
  
• Medicines: You may have any of the following:
  
  
  • Antibiotics: Antibiotics may be given to help treat or prevent an infection caused by germs called bacteria.
    
    
  • Antinausea medicine: This medicine may be given to calm your stomach and control vomiting (throwing up). Pain medicine may upset your stomach and make you feel like vomiting. Because of this, pain medicine and anti-nausea medicine are often given at the same time.
    
    
  • Diuretics: This medicine is often called "water pills". Diuretics help your body get rid of extra fluid (edema) in your legs and ankles. This medicine may also help get rid of extra fluid in your lungs or around your heart. It may also decrease your blood pressure. You may urinate more often when taking diuretics.
    
    
  • Clot busters: This medicine helps break apart blood clots, which may increase blood flow to your heart muscle. It is given in your IV and may be given at the same time as other blood thinners. This medicine may decrease the amount of damage to your heart muscle, and may even save your life. You will bleed and bruise more easily after getting clot busters.
    
    
  • Heart medicine: This medicine may be given to make your heart beat stronger or more regularly. There are many different kinds of heart medicines. Talk with your caregiver to find out what your medicine is and why you are taking it.
    
    
  • Pain medicine: Caregivers may give you medicine to take away or decrease your pain. Tell caregivers right away if you start feeling discomfort, 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. Any of these may be a sign that your heart is not getting enough oxygen, and may need medicine to help.
  
  
• Monitoring: Caregivers may check for your pulses on your arms or feet. This may help the caregiver to learn if you have problems with blood flow after your open chest maze procedure. You may also have the following:
  
  
  • Heart monitor: This is also called an ECG, electrocardiogram, or telemetry. Sticky pads are placed on your chest or different parts of your body. Each pad has a wire leading to a small portable box (telemetry unit), or to a TV-type screen. This lets caregivers see a tracing of the electrical activity of your heart. The heart monitor may help caregivers see problems with the way your heart is beating. Do not remove any wires or sticky pads without asking your caregiver first.
    
    
  • Pulse oximeter: A pulse oximeter is a machine that tells how much oxygen is in your blood. A cord with a clip or sticky strip is placed on your ear, finger, or toe. The other end of the cord is hooked to a machine. Caregivers use this machine to see if you need more oxygen.
  
  
• Pneumatic boots: These are plastic boots or leggings put on your feet or legs over pressure stockings or ace wraps. The boots or leggings are connected to an air pump machine. The pump tightens and loosens different parts of the pneumatic boots. This helps push the blood back up to the heart to keep clots from forming.
  
  
• Temporary pacemaker:
  
  
  • This is a machine that helps your heart beat at a normal speed and in a regular rhythm. A temporary pacemaker may use large patches placed on your chest and back. These are connected to a special monitor. Sometimes, your caregiver may need to put small wires through your skin and into your heart muscle instead. The wires may then be connected to a small pacemaker box outside of your body.
    
    
  • The temporary pacemaker "reads" what your heart is doing. If your heart is beating in a different way than it should, the pacemaker takes over and controls your heartbeat. It does this by sending small electric signals to the heart muscle. This tells your heart when to beat. You may feel these signals, especially if your temporary pacemaker uses large patches on the skin. If this causes pain, use your call light and tell your caregiver. Do not get out of bed without first asking your caregiver if it is OK. You may need a pacemaker just for a short time. In some cases, you may need it for the rest of your life. If so, your caregiver may replace your temporary pacemaker with a permanent one.
  
  
• 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).

Copyright © 2008 Thomson Healthcare Inc. All rights reserved. Information is for End User's use only and may not be sold, redistributed or otherwise used for commercial purposes.

The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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