What is thoracoscopic maze procedure?

The thoracoscopic maze is the most advanced procedure for atrial fibrillation available today. Due to the procedure’s unique access to the heart, all areas responsible for atrial fibrillation (abnormal heart rhythm) are isolated into close, but separate compartments, or “boxes.” The surgery is sometimes called the Five Box Thoracoscopic Maze procedure.

The original Cox maze procedure, developed in 1992, used an open-chest, non-beating heart approach. Multiple incisions were made in the atria in order to create electrically isolated corridors, thereby isolating atrial fibrillation from the heart and allowing normal conduction of the heart beat. Although a technically complex and invasive procedure, the Cox maze produced a published cure rate of 95 percent, even for persistent atrial fibrillation.

The five-box thoracoscopic maze, similar to the Cox maze, uses pencil-size port incisions (cuts) in the chest and is performed with a beating heart. Instead of incisions in the heart, bipolar electrical energy sources create full-thickness ablations (removal of tissue) in the atrial muscle to isolate the areas that cause atrial fibrillation.

The thoracoscopic approach gives a clear view of the heart, enabling unmatched precision without X-rays. Moreover, all ablations are thoroughly tested in real time, resulting in a complete procedure for every patient.

Why choose Ohio State for thoracoscopic maze procedure?

The Ohio State University is one of only a few institutions nationwide where maze surgery is performed using a truly minimally invasive, totally thoracoscopic maze procedure that achieves cure rates equivalent to the original Cox maze procedure developed in 1990s. Dr. John H. Sirak is a recognized innovator in this technique of replicating a complete procedure for atrial fibrillation (also known as afib or AF) that is approached through a few pencil-sized incisions in the chest.

The Ohio State University Ross Heart Hospital offers the region's only fully dedicated cardiovascular patient facility. The nursing staff is highly experienced in the care of all cardiac surgical patients.

All patients stay in spacious, state-of-the-art, private rooms which focus on each individual patient. Rather than transferring between nursing units midway through their hospitalization, patients stay in the same private room until discharged. This minimizes any inconvenience to patients and their families.

What to expect during a thoracoscopic maze procedure

Preparing for your procedure

Prior to your maze procedure, you’ll meet with your doctor to discuss your medical history, the medicines you take and any questions you have about the procedure.

Once you have been scheduled for the procedure, you undergo several non-invasive tests including:

  • Chest X-ray – A radiograph or picture of the heart and lungs including blood vessels, ribs and bones of the spine
  • Echocardiogram (also called echo) – This test uses sound waves to assess the function and structure of the heart muscle and valves
  • Nuclear stress test – A scan that measures the blood flow to the heart muscle during rest and during activity or stress to determine if areas of the heart muscle have low blood flow or are damaged

During your procedure

You are asleep and lying on your back for the procedure. Four tiny incisions are made on each side of the chest. The pericardium, or fibrous sac enclosing the heart, is opened. The thoracoscope provides clear, magnified visualization for precise identification of all key anatomy. The patient is not exposed to X-ray radiation.

Bipolar electrical energy creates controlled “burns” in the atrial (upper chamber) of the heart. It creates barriers around the tissue areas responsible for atrial fibrillation. The advantage of bipolar is that it heats the tissue between two electrodes. This is an important distinction from other procedures that generate heat at the point of contact with the tissue.

Electrical isolation is confirmed within each box and ablations are repeated until the five compartments are created and confirmed.

The small incisions used in the operation result in limited discomfort, which typically goes away by the second postoperative day. The thoracosopic maze takes about 3-1/2 hours to complete.

After your procedure

After surgery, you are cared for in one of the beautiful, state-of-the-art, private rooms in the Richard M. Ross Heart Hospital. Depending on your recovery, you will stay in the hospital for one to two days. Each room is comfortably arranged to include a pull-out sofa and private bathroom so that your loved ones can stay with you. We value and embrace family participation in every aspect of your care. Upon discharge from the hospital, you will have no activity restrictions. However, it is recommended you do not drive for two to three days after discharge to ensure the anesthesia is completely worn off. Provided you are feeling well, you should be able to return to work in approximately seven days.

At discharge, you schedule an appointment in the outpatient clinic one month after surgery. You can expect to receive a remote heart monitor at three-, six-, 13-, and 24-month intervals after surgery to assess your rhythm status.

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