Question on MAZE procedure

Gldngrl · Feb 3, 2004

Here's an article on medscape on MAZE procedure for treatment of atrial fibrillation:

http://www.medscape.com/viewarticle/422889

If the link doesn't work, you can go to medscape and subscribe for free, put in MAZE for search term. I can't find out if MAZE is a acronym or if the procedure was named after someone. Hope this helps.

Whisper · Feb 3, 2004

Thanks very much for the link.

I think Maze may be a person, rather than an abreviation, I tried looking it up on on line medical abreviation pages with no luck.

But the conference report looks really great, I also found a BMJ one which is quite old and oinly mentions the procedure as part of a regime for treating AF.

Here is the reference:

BMJ 1995;311:1562-1565

I went to the BMJ's home page and typed in Maze procedure, and It was I think the third article.

So I have one good article, one good but old-ish article and two that are very much like advertisements for US clinics.

Thanks again

Whisper

Whisper · Feb 4, 2004

I am not sure if any one else is reading this, but I thought I would share in case it helps some one else!

from what I have been reading it sounds like Maze proced ure aka Cox Maze iii procedures have been performed in the US for decades, and we just started at this hospital in the last month!

This article looks good but I only have access to the summary:

J Thorac Cardiovasc Surg. 2003 Dec;126(6):1822-8.

Hope it helps some one else

whisper

2ndCareerRN · Feb 4, 2004

I am not sure who or what it is named for.

But, I can give some experience with it. My wife is a congential heart that had her first surg when she was 9 y/o (early 60's). She had an ASD that involved the tricuspid and mitral valves. A cleft mitral leaf. A small VSD.

Several years ago she went into A-Fib. After several attempts to control with cardioversion it still wasn't going away. Because she was going in to have a major tune-up, Gore-Tex patch, Annular rings on mitral and tricuspid valve, sewing of the cleft leaf, we decided to try the maze procedure also.

She had the surg, had a hospital stay, and then was still getting light headed with exertion. Back on the treadmill to find out her heart no longer compensated. Her rate would not go above 80.

Next step was a pacemaker that senses her moving or having an increase in resp, which then kicks her rate up to the 140's. Not sure if it is working or not. She still gets winded when we walk the mall, or try to do anything else.

I am not sure how many of these procedures have been done, being an open procedure with bypass, but it would seem radio ablation would be the first choice. IMO

Supposed to have an 80%+ success rate.

http://www.sts.org/doc/4511

http://www.umm.edu/heart/maze.html

Recovery time is shorter when patients undergo a minimally invasive variant of the procedure that was recently introduced by the designer of the original maze procedure, Dr. James Cox at Georgetown University

http://www.heartcenteronline.com/myheartdr/common/articles.cfm?ARTID=559

So, it looks like the procedure is named for the cuts made in the atriums, and was developed by Dr James Cox. You may want to try a search on Cox-Maze, it may give more results.

bob

Dinith88 · Feb 4, 2004

Whisper,

Is your facility doing open MAZE procedures for patients who otherwise wouldn't require open heart surgery? We recently (within last 2weeks) had a patient undergo a MAZE procedure during an MVR. She had a chronic AF and since the surgeon was "going to be there anyway", he preformed the MAZE. I'm curious to know if you guys are putting people under the knife and on bypass pumps just to cure the a-fib, or if it's reserved for patients who're having an open-heart (and have a Hx of AF) . A surgical MAZE/openheart/bypass-pump procedure done soley to 'cure' AF is rarley done and reserved for severley debillitating(sp?) cases refractory to all the conventional treatments...or so i thought?

And how are these patient's responding in your experience to-date?

(BTW, the PT we took care of within the last 2 weeks was in NSR immediately post-op but then reverted to AF. When i questioned the CVsurgeon regarding this, he told me that in MAZE procedures, the patient needs 3-6 months 'healing time' to determine if it will work. Apparently the swelling/irritation from the MAZE lesions can cause AF)

zambezi, BSN, RN · Feb 4, 2004

Our cardiac surgeons occassionally do maze procedures while they are doing a cabg or valve...with the maze procedure, tiny cuts are made on the myocardium (i believe with a laser) to ablate alternate pathways...as others have mentioned, it is ususally used for those that have chronic afib...in my experience, these patients often have some bouts of junctional rhythm after surgery, occassionally requiring pacing...

Whisper · Feb 4, 2004

Originally posted by Dinith88
Whisper,

Is your facility doing open MAZE procedures for patients who otherwise wouldn't require open heart surgery?
And how are these patient's responding in your experience to-date?

I have only seen one patient having a maze procedure, and he also had 3CABG. I think there is one planned case for next week which is AVR and Maze.

The patient I saw came back from theatre in AF, and was still in AF on discharge... I think 15/7 after surgery, but there were other complications. They also seemed to have pacing wires in for a heck of a long time...

I had never heard of a maze before and they are very new to this area.. I think the patient I looked after was the third to have it performed here!

Thanks for all the help, I am back there tommorow for an E/L so hopefully someone will look at all the research I have collected (yeah right... pig flying!) but at least I won't stare blankly at handover any more:)

Whisper

Noney · Feb 11, 2004

Thanks for all the info. Whisper it doesn't sound like you've got a very nice mentor.

Noney

Whisper · Feb 11, 2004

Thanks for all the info. Whisper it doesn't sound like you've got a very nice mentor.
Noney

They are being nice to me at the moment, my first few shifts were bad, I wasn't able to do anything except beds and baths, but we had a shift from hell... one pt went off and was rushed back to ICU and we had three more that looked like they were attempting to go off, my mentor had the ward and had to help out in the ward HDU, I took over her patients and got another RN to do the medicines with me. I think (hope) she was impressed, the only thing I forgot to do was change one pts Huggy towel but I was able to do that after I had handed her patients back to her.

I actually do like my mentor, I was just annoyed, and always am, when people say go look it up, especially when I don't have a clue where to start! I think it must be hard for RNs to have students,you don't always know what students are capable and competent to do, the first few weeks must feel like baby sitting for you!

Havin' A Party!, ASN, RN · Feb 13, 2004

... A surgical MAZE/openheart/bypass-pump procedure done soley to 'cure' AF is rarley done and reserved for severley debillitating(sp?) cases refractory to all the conventional treatments...or so i thought?

Believe this is absolutely correct. Tremendous amount of trauma and lengthy recovery.

Hugely successful though for AF, from what I've read.

versatile_kat · Feb 14, 2004

Hey guys, just wanted to let you know that Maze doesn't stand for anything ... it means exactly what it is - a "maze" inside the right atrium for the SA node to fire to the AV node through. All of the scar tissue inside the atria (which takes on average about 4 weeks to develop) makes a pathway for only one electrical impulse (SA to AV), instead of several aberrant impulses as with afib. It's an excellent procedure with (I believe) a 98% success rate for chronic afibbers. Please correct me if I'm wrong :) . I work in a busy cardiac surgical unit that has recently done about one maze a week (along with the cabg), but you're right, it doesn't happen all that often. Hope this info helps!