In earlier times, most of the surgeries were handled in a way, where the surgeon’s hands used to do most of the activity. With passing time, newer types of equipment have been getting introduced by worldwide healthcare professional and medical researchers. Not only this, over the years, the line between technology and medical science has become extremely thin. Today, there are exceptional kinds of treatment and surgeries possible, which once upon a time were thought to be unimaginable. These days, with the help of an extremely smart surgical apparatus, the surgeons are treating some of the most complicated health conditions.
Talking more specifically about the field of Cardiology, it has undergone drastic kind of evolution. Highly updated methodologies have been introduced to this field, keeping in kind maximum patient comfort and minimum discomfort. Be it the people belonging to the older generation or the younger generation, Cardiac ailments are very common today and the leading reason behind the continually escalating mortality rates. To cut down the number of Heart patients, among the many kinds of the treatment and surgical possibilities that are viable today, Maze Surgery is one of them.
Overview: Maze Surgery
There are electrical impulses in the Heart muscle, also known as the Myocardium. These impulses cause the Heart to beat or contract. The electrical signal starts in the sinoatrial (SA) node, which is located at the top of the Heart’s upper-right chamber, the right atrium. The SA node is also known as the Heart’s ‘natural pacemaker’. When this SA node releases an electrical impulse, the Atria contracts. Then, the signal passes via the Atrioventricular (AV) node. The AV node sends this signal through the muscle fibres of the lower chambers, which are the ventricles, causing them to contract. Any irregularity in this whole system affects the Heart’s natural rhythm. These irregularities are called Arrhythmias.
When the above mentioned electrical system faces problems, the Heartbeats either too slow or too fast, which is Atrial Fibrillation. Some of the diseases that can cause this include High Blood Pressure or Coronary Artery Disease. Atrial Fibrillation can also occur in patients without any other signs of a Heart ailment. It is more common in younger people and this condition is called Lone Atrial Fibrillation.
What are the causes of Atrial Fibrillation?
Apart from the above-mentioned cause, which is the primary cause, there are various other causes behind the development of Atrial Fibrillation:
- Hyperthyroidism or overactive Thyroid
- Excessive consumption of alcohol
- Pulmonary embolism, which refers to a blockage in the primary artery of the Lung
- Abnormal Heart valves
- Sleep Apnoea
- Sick Sinus syndrome
- Left Ventricular Hypertrophy or enlargement of the ventricular walls
- Coronary Heart Disease
- High Blood Pressure
- Congenital Heart defects
- Myocardial Infarction
- Age of the patient
Who are the Candidates for Maze Surgery?
The Maze Procedure is primarily done to treat an Arrythmia or irregularities in the heartbeat, known as chronic Atrial Fibrillation (AF). AF is a fast and irregular Heart rhythm, in which the upper chambers of the Heart contract in a clumsy and inharmonious manner. Apart from the usual coordinated contractions during the Heartbeat, there is twitching or fibrillating movement. This condition is very dangerous as it may cause the blood to pool in these chambers and the pooled blood can lead to the formation of clumps of blood, generally known as blood clots. If a blood clot travels from the Heart and block any small artery of the Brain, then the patient may suffer a stroke.
Other reasons include:
- Unsuccessful catheter ablation
- Blood clots in the left atrium
- Metoprolol (Lopressor, Lopressor LA, Toprol XL)
- Enlarged left atrium
- History of stroke
- Other conditions requiring heart surgery
Evaluation before Maze Surgery
- Electrocardiogram: In this, there are small sensors or electrodes attached to the patient’s chest and arms that help in sensing and recording the electrical signals, while they travel through the Heart.
- Holter Monitor: This is a portable ECG device, which the patient needs to carry in the pocket or can also be worn on a belt or shoulder strap. It records the Heart’s activity for about 24 hours, which gives the surgeon an opportunity to get a detailed look at the Heart rhythms
- Event Recorder: This is a portable ECG device that monitors the Heart’s activity over a period of some weeks to months. The patient needs to activate the monitor only when he or she faces symptoms of fast heartbeats
- Echocardiogram: This is a non-invasive test, in which sound waves are used to form a video image of the Heart.
- Another form of Echocardiogram is where a thin tube with a transducer is passed through the Throat into the Oesophagus, and hence it is known as Trans-oesophageal Echocardiography. In this too, sound waves are used
- Blood Tests: With the help of this, the surgeon finds out if there are any Thyroid issues or if there are any substances in the patient’s blood, that are causing Atrial Fibrillation
- Chest X-ray: Help the surgeon to assess the condition of the patient’s Heart and Lung
- Stress Test: Also known as Exercise Testing, in this, there are tests conducted while the patient exercises
Getting ready for the Procedure
Following are some of the points that are crucial while the patient is preparing for the Maze Surgery:
- Avoid eating or drinking anything post-midnight prior to the surgery
- It is recommended that the patients stop smokingat least two weeks before the surgery otherwise there may be issues related breathing and blood clotting
- The patient needs to stop the consumptions of certain medications and health supplements
Also, there are some tests that are required to assess the health condition of the patient:
- Chest X-ray
- Blood tests
- Urine test
- Electrocardiogram (ECG), the check the Heart rhythm
- Echocardiogram, to evaluate the Heart’s structure and function
How is Maze Surgery done?
For Maze surgery, there is the traditional approach and a less invasive approach as well. The Maze Surgery is often recommended for patients, who are suffering from Atrial Fibrillation along with other Heart ailments like Coronary Artery Disease or valve diseases.
The choice depends on the patient’s requirement and the preference of the surgeon. The traditional method in implemented in the following manner:
- The patient is administered anaesthesia before the surgery
- A blood-thinning medicine or an anticoagulant is given to prevent the formation of any blood clots
- The patient is connected to a respirator that helps with breathing
- The patient is then connected to a Heart-lung machine, which acts as the Heart and Lungs during the surgery. The machine removes carbon dioxide and swaps it with oxygen
- Also, the machine allows the surgeon to stop the Heart’s beating and perform the surgery on a still Heart
- A Catheter is inserted into the Bladder to collect any urine produced while the surgery is in process
- The surgery takes about three hours to get done
- Then, a big incision is made down the middle of the patient’s chest, through the breastbone or the Sternum; the breastbone is separated
- Then the surgeon makes many cuts through the Atria and then sews them back together. Or, the surgeon may use radiofrequency energy or other source of energy to eliminate small areas of tissue
- The energy sources that may be used, include:
- Radiofrequency: A radiofrequency energy catheter is used to make the lesions or incisions in the Heart
- Microwave: This involves the usage of a wand-like catheter to direct the microwave energy to generate the lesions in the Heart
- Cryothermy, also known as Cryoablation: Very cold temperatures are transmitted via a probe, called the Cryoprobeto make the lesions.
- Once done, the surgeon wires the breastbone together and finally, sews or staples the cuts on the skin
- Once finished, the patient is disconnected from the Heart-lung machine
Thankfully, not everyone requires the traditional approach or the Open Heart approach. Fortunately, for patients, who do not any other Heart issues other than Atrial Fibrillation, the minimally invasive version of the Maze Surgery can be very advantageous.
- It is known as the Mini-maze Procedure
- Requires only a few hours to finish
- Doesn’t need big cuts in the Sternum; only three keyhole incisions on each side of the Chest
- The surgeon passes specialized surgical instruments via these incisions, instruments including an ablation device, as well as a Thoracoscope. The Thoracoscope or an Endoscopeis a camera and a direct vision device, which allows the surgeon to get a clear visual of the Heart
- Small tubes called Catheters are also passed through the incisions to reach the Heart. Then, a flexible Ablation device is passed via the Catheters
- This device provides hot or cold energy to the Atrial tissue that destroys or ablates portions of the Atrium in specific consecutive areas, which forms a design of scar tissue. This pattern creates something like a ‘maze’ of fresh electrical pathways. This helps the electrical impulses to travel comfortably through the Heart
A recent minimally-invasive version is the Paracardioscopic Ex-Maze. In this, a small circular incision is made in the abdomen and the process is done by accessing the back of the Heart, going via the Diaphragm. Also possible is the minimally invasive Maze Surgery using robotic assistance.
Benefits of Maze Surgery
- With the help of Maze Procedure, the patients get relief from the difficult symptoms of Atrial Fibrillation, such as:
- Breathing difficulties
- Chest pain
- Weakness, and others
- An improved quality of life – more energetic
- The minimally invasive approach offers the same benefits similar to the traditional approach, along with other benefits like:
- Lesser bleeding
- Short hospital stays
- Rapid recovery
- Smaller incisions and thus, cosmetic benefits
Risks and Complications associated with this procedure?
The way healthcare technology has progressed, the amount of complications associated with any surgery has gone down for any healthcare specialty. For Cardiac Surgeries too, thankfully, the patients are in a much better situation as the usage of advanced equipment has taken the accuracy level to an altogether different level. For Maze Procedure, very rarely, there can be a few complications that the patients may come across, such as:
- Abnormal Heart rate
- Blood clots, that can lead to the occurrence of a stroke or Heart Attack
- Kidney Failure
- Anaesthesia related complications
- One of the major risks is that the surgery may not address the issue of Atrial Fibrillation or, the problem may relapse shortly after the surgery or after a few months
- Eat food items that are good for the Heart health. Work out a proper diet chart with the doctor or a Dietician, to start a diet regimen that’s low in salt and solid fats, and rich in vegetables, fruits, and whole grains
- Exercise daily and try to increase your physical activity, without straining yourself too much
- It is advisable to quit smoking. If you smoke and are not able to quit on your own, take your doctor’s help to know about programs or strategies to help you
- Maintain a reasonable body weight. Being overweight ups the risk of developing Heart ailments
- Keep Blood Pressure and Cholesterol levels under check. Be prepared for lifestyle changes and if suggested, take proper and prescribe medications to control High Blood Pressure (Hypertension) or high Cholesterol.
- Avoid too much alcohol consumption
- Be very regular about the follow-up care. You must take the medications as prescribed and have regular follow-up appointments with their doctor
- Be very wary about any kind of uneasiness or unusual symptoms and do get in touch with your doctor at the earliest
- Fortis Hospitals
- Apollo Hospitals
- Medanta – the Medicity
- CARE Hospitals
- BLK Super Specialty Hospital
- Sakra World Hospital
- Sparsh Hospital
- Paras Hospitals
- KokilabenDhirubhai Ambani Hospital &Medical Research Institute
- Alchemist Hospitals
After Maze Surgery
The hospital stay after a Maze Surgery is of about 5-7 days, including a couple of days’ stay in the Intensive Care Unit (ICU). The patients are given appropriate medicines known as diuretics to avoid any unwanted fluid build up. Also, the patients are also given Aspirin for about six weeks after the surgery. This helps in avoiding the formation of any blood clots.
Like any other Heart surgery, recovery is extremely crucial to avoid facing any post-surgery complications. In most cases, it takes about two months for recovery. The patients may have little pain near the location of the incision/incisions. The incision site should be kept clean and dry for fast healing. The patients might feel more fatigue than usual. But there is nothing to worry because this is normal. Most patients enjoy a smooth recovery period and recuperate completely in about three months. Furthermore, the success rates of this particular procedure are very high – almost 90-98 percent of the patients experience maximum surgical benefits and the chances of complications are hardly there. It is surely an extremely safe Heart procedure and with time, this procedure has gained a lot of popularity.
Changes in Lifestyle and Home Remedies
After any surgery, it is very vital the patients alter their lifestyle habits to enjoy maximum results of the surgery. Some of the points that the patients need to keep in mind are:
Why choose India for Maze Surgery?
In the matter of healthcare, among the many countries around the globe, India has captured the attention of globally located patients owing to the presence of the most patient-friendly factors. First and foremost is that India is very strategically located and is accessible from any corner of the globe, which makes it easier for the medical value travelers. Then the hospitals, which are setting new benchmarks with each passing year, are investing a lot to upgrade and maintain their equipment; particularly related to Cardiac treatment. The patients get a very safe and home-like ambiance here, with supremely talented surgeons and very caring nursing staff.
The chances of any complications affecting the patients are very rare, thanks to the amazing bunch of Cardiac surgeons. These surgeons are thoroughly learned about each and every aspect of Cardiology and have earned a huge amount of respect for their proficiency. Their remarkable success rates are the result of their meticulousness and dedication towards their patients. Not only this, considering the fact that the healthcare expenditure is going up with every passing year, finding a reasonably priced treatment is more than welcome today. In this matter, India is providing massive relief with all kinds of modern treatment and procedures available here at very affordable prices. Even for cutting edge Heart surgeries like the Maze Surgery, the patients do not have to shell out an exorbitant amount.
As more and more hospitals in India adopt modern Heart treatment technique like Maze Technique, India as well as a huge chunk of international patients have a huge ray of hope of getting cured, that too, in a cost-effective way. The below-mentioned surgeons and hospitals in India are undeniably some of the most recognized names associated with Cardiac cure; specifically, with Maze Surgery.
All of these attributes put together, India is undeniably a very attractive venue for the medical value travellers in need for this surgery.
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