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. 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

• 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.
  
  
• You may get a blood clot in your leg or arm. This can cause pain and swelling, and it can stop blood from flowing where it needs to go in your body. The blood clot can break loose and travel to your lungs or brain. A blood clot in your lungs can cause chest pain and trouble breathing. A blood clot in your brain can cause a stroke. These problems can be life-threatening.
  
  
• 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. Ask your caregiver if you have questions about your open chest maze procedure.

Getting Ready

The week before your open chest maze procedure:

• Ask a family member or friend to drive you home after your surgery. Do not drive yourself home.
  
  
• Ask your caregiver if you need to stop using any of your present medications. These may include aspirin, ibuprofen, or blood thinners.
  
  
• Ask your caregiver before using any over-the-counter or herbal medicine or supplement. If you regularly use these medicines or supplements, tell your caregiver.
  
  
• Dye may be used during your open chest maze procedure to help caregivers see the blood vessels better. People who are allergic to iodine or shellfish (lobster, crab, or shrimp) may also be allergic to this dye. Tell your caregiver if you are allergic to any of these.
  
  
• You may be asked to stop smoking. Ask your caregiver for more information if you have trouble stopping smoking.
  
  
• You may need to stop driving, lifting heavy things, or doing strenuous or tiring activities.
  
  
• You may need to have an electrocardiogram (ECG), electrophysiologic studies (EPS), or transthoracic and transesophageal electrocardiogram (TEE). You may also need to have a cardiac catheterization, head computed tomography (CT) scan, chest x-ray, and blood tests. Ask your caregiver for more information about these and other tests that you may need. Write down the date, time, and location of each test.
  
  
• Your caregiver may give you heart medicines to help control your irregular heartbeat. Ask your caregiver for more information about these medicines.

The night before your open chest maze procedure:

• Ask caregivers about directions for eating and drinking.
  
  
• Your bowel may need to be emptied and cleaned out before the surgery. Caregivers may give you a liquid medicine called an enema. This will be put into your rectum (rear end) to help empty your bowel. Your caregiver will teach you how to do this.
  
  
• You may be given a pill to help you sleep.

The day of your open chest maze procedure:

• Write down the correct date, time, and location of your procedure.
  
  
• Ask your caregiver before taking any medicine on the day of your open chest maze procedure. These medicines include insulin, diabetic pills, high blood pressure pills, or heart pills. Bring all the medicines you are taking, including the pill bottles, with you to the hospital.
  
  
• Do not wear contact lenses on the day of your open chest maze procedure. You may wear glasses. Wear socks to help you stay warm.
  
  
• Bring your personal belongings with you. These may include your bathrobe, toothbrush, denture cup (if needed), hairbrush, and slippers.
  
  
• Caregivers will insert an intravenous tube (IV) into your vein. A vein in the arm is usually chosen. Through the IV tube, you may be given liquids and medicine.
  
  
• An anesthesiologist may talk to you before your open chest maze procedure. This caregiver may give you medicine to make you sleepy before the procedure.
  
  
• You or a close family member will be asked to sign a legal piece of paper (consent form). It gives your caregiver permission to do an open chest maze procedure. It also explains the problems that may happen with the procedure, and your choices. You may also be asked to sign a consent form for bypass surgery in case problems are found during this procedure. Be sure all your questions have been answered before you sign this form.

Treatment

What will happen:

• You may be given medicine to help you relax or make you drowsy. You will be taken on a cart to the operating room and then moved into a special bed. The hair on 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. Caregivers may give a general anesthesia to keep you asleep during your procedure. An endotracheal tube (ET) connected to a breathing machine may be put into your mouth or nose. The tube is used to keep your airway open and help you breathe during your procedure.
  
  
• Your caregiver may need to insert a pulmonary artery catheter to see how well your heart is working. A catheter is a tube that is threaded into your heart through a blood vessel in your chest, neck, arm, or leg. Another tube with a small ultrasound sensor may also be placed down into your esophagus (food pipe). Since your esophagus is right next to your heart, your caregiver can see your heart clearly. During your open chest maze procedure, a large incision (cut) in your sternum (breastbone) will be made 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 take your vital signs every 15 minutes for 1 to 2 hours. The pulses in your arms and feet will be checked often. Caregivers will watch you closely for problems that can happen after your open chest maze procedure.
  
  
• Caregivers may leave you connected to a ventilator (breathing machine) after surgery to give you oxygen. The ET tube may be removed after you are awake and can breathe well on your own. 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.

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.

Contact a caregiver if

• You cannot make it to your open chest maze procedure appointment on time.
  
  
• You have a fever.
  
  
• You have questions or concerns about your open chest maze procedure.

Seek Care Immediately if

• Call 911 or an ambulance if you have any signs of a heart attack:
  
  
  • Discomfort in the center of your chest that feels like squeezing, pressure, fullness, or pain, that lasts for more than a few minutes or keeps returning
    
    
  • Discomfort or pain in your back, neck, jaw, stomach, or one or both of your arms
    
    
  • Feeling sick to your stomach
    
    
  • Having trouble breathing
    
    
  • A sudden cold sweat, particularly in combination with chest discomfort or trouble breathing
    
    
  • Feeling very lightheaded or dizzy, particularly in combination with chest discomfort or trouble breathing
  
  
• You have signs of a stroke: The following signs are an emergency. Call 911 immediately if you have any of the following:
  
  
  • Weakness or numbness in your arm, leg, or face (may be on only one side of your body)
    
    
  • Confusion and problems speaking or understanding speech
    
    
  • A very bad headache that may feel like the worst headache of your life
    
    
  • Not being able to see out of one or both of your eyes
    
    
  • Feeling too dizzy to stand

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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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