Maze Surgery: Why Choose Penn Medicine

Penn Medicine’s cardiac surgeons have deep experience performing the leading surgical approach for atrial fibrillation — the Maze procedure — without a large incision. Patients from across the region choose Penn for surgical treatment of atrial fibrillation because of our:

  • Outcomes: Because Penn’s cardiac surgeons perform a high number of Maze procedures (also known as Cox-Maze), our results are impressive. The vast majority of patients have symptom relief following the procedure.
  • Expertise: Other centers refer patients with complex cases of atrial fibrillation to Penn cardiac surgeons. We routinely provide care for patients who were told arrhythmia surgery isn’t an option. We also use the Maze procedure to successfully treat patients with mitral valve regurgitation and mitral valve stenosis in addition to atrial fibrillation.
  • Innovation: In recent years, our surgeons have performed minimally invasive Maze procedures to treat patients with atrial fibrillation who also need aortic valve surgery

Atrial Fibrillation Surgery Overview

The upper heart chamber is known as the atrium. There are two chambers, right and left. When an abnormal heart rhythm (arrhythmia) occurs in the atrium, it is known as atrial fibrillation (A-Fib). A-Fib is the most common type of arrhythmia. It can severely impact quality of life.

The Maze procedure blocks the faulty electrical impulses that cause A-Fib. Your surgeon creates a maze of scars in the heart tissue. This scar tissue interferes with the conduction of electricity and can correct arrythmia.

Surgeons usually reserve the Maze procedure for patients who also need additional treatment like heart valve treatments or removal of the left atrial appendage (LAA). The LAA is where blood pools and clots form in patients with A-Fib.

In many cases, less invasive treatments are effective for A-Fib, so surgery isn’t necessary. Learn more about treatments available within the Penn Cardiac Arrhythmia Program.

Procedure Details: Traditional Cox-Maze Procedure 

With the traditional Maze procedure your surgeon works closely with a cardiac anesthesiologist to ensure you’re asleep and comfortable. Next, they:

  • Create an incision through the breastbone (sternotomy) to access the heart. 
  • Use cardiopulmonary bypass with a heart-lung machine to take over the work of your heart, so your heart is still while the surgeon works.
  • Create scars. These methods can be used to generate scar tissue: 
    • Scalpel: This approach creates scar tissue by cutting into the heart tissue. 
    • Radiofrequency: This approach uses heat energy to create scar tissue.
    • Cryoablation: This approach uses extreme cold to generate scar tissue.
  • Perform other procedures like valve repair or pacemaker placement while you remain under general anesthesia.
  • Remove you from the heart-lung machine and close the incision. You will recover in a room just outside the operating suite before being transferred to a room in the intensive care unit (ICU).

Procedure Details: Mini-Maze Procedure 

Today, Penn cardiac surgeons can routinely access the heart through much smaller incisions. The use of cardiopulmonary bypass isn’t necessary. To perform a minimally invasive Maze (mini-Maze) procedure, your surgeon and anesthesiologist use general anesthesia. Then, your surgeon:

  • Creates one 3- to 4-inch incision or several one-half inch incisions through the chest wall between the ribs (thoracotomy).
  • Inserts tiny surgical tools like high-definition cameras and surgical instruments through the chest incisions to access the heart.
  • Creates scar tissue with the same scar-generating methods as with the traditional Maze procedure.
  • Closes the incision(s) to begin the recovery process.

Catheter Ablation

Because surgery is generally a last resort for A-Fib, your care team may recommend catheter ablation. This type of procedure uses only a tiny incision in the groin. Penn electrophysiologists have an extensive track record of successfully using catheter ablation for A-Fib with excellent outcomes.

Your doctor can also use a minimally invasive approach to insert an LAA device that prevents blood clots from forming. Learn more about the WATCHMAN™ device. 

Cardiac Rehabilitation

You will recover in the hospital for several days. The length of stay depends on the type of procedure your surgeon performs. Typically, recovery from minimally invasive heart surgery is faster than with traditional surgery.

To help you quickly return to an active lifestyle, your surgeon may recommend you undergo cardiac rehabilitation when you leave the hospital.

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