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Less invasive approaches have transformed surgery in many medical specialties, particularly  cardiac surgery. Smaller incisions translate to less blood loss, less post-operative discomfort, shorter hospital stays, quicker recovery and a generally more rapid return to normal activities.

One such procedure is a minimally invasive approach for the maze procedure to treat atrial fibrillation. We sat down recently with an expert in this procedure, Dignity Health–Sequoia Hospital’s Luis Castro, MD, director of Cardiac Surgery, to talk about maze and what it means for patients.

 Q: Tell me a little about atrial fibrillation? What are the symptoms? Who is at risk?

Atrial fibrillation (also known as AFib) is a type of irregular heartbeat that occurs when the upper chambers of the heart (the atria) beat too fast and in an uncoordinated way. This can lead to a number of symptoms, including heart palpitations, shortness of breath, fatigue and dizziness. In some cases, AFib may not cause any symptoms at all.

AFib is a relatively common condition, and it can affect people of all ages — 10 percent of us will develop the condition by the time we reach 80. Some people may be at a higher risk of developing AFib than others, including those who have high blood pressure, heart disease, sleep apnea, diabetes or a family history of AFib. Other risk factors may include obesity, smoking, excessive alcohol consumption, and certain types of lung disease. However, it’s important to note that not everyone with AFib will have these risk factors, and some people with risk factors may never develop the condition.

 Q: What is the maze procedure? How is the procedure performed?

During the maze procedure,  we create a series of carefully placed incisions in the atria (the upper chambers of the heart) to create a maze-like pattern of scar tissue. This scar tissue helps to interrupt the abnormal electrical signals that cause AF and can help to restore the heart’s normal rhythm.

The maze procedure can be performed using different surgical techniques, including traditional open-heart surgery, minimally invasive surgery, and robotic-assisted surgery. It may be used in combination with other treatments, such as medication or ablation therapy, depending on the individual case. The hybrid approach for the maze procedure for atrial fibrillation is a newer technique that combines elements of both surgical and catheter-based approaches to treat AFib.

In our hybrid operation, the approach begins with a surgical epicardial maze operation performed minimally invasively by making several keyhole incisions along the chest wall. Working instruments via camera guidance permit exact anatomical ablation of atrial tissue as well as exclusion of the left atrial appendage. The second part of our approach is performed in the catheterization lab, reinforcing any potential gaps in ablation through targeted endocardial catheter ablation. This combination of surgical ablation and catheter-based ablation can help to achieve a more complete and precise ablation pattern, while also reducing the invasiveness of the procedure compared to traditional open-heart surgery.

The hybrid approach may be particularly valuable for people with more complex cases of AFib, or for those who have previously undergone unsuccessful ablation procedures.

Q: What is the success rate for the maze procedure at Sequoia?

The success rate of the maze procedure can be quite high, with many patients experiencing a significant improvement in their symptoms and a reduced risk of complications. For example, a systematic review of studies published in the Journal of Thoracic and Cardiovascular Surgery found that the success rate of the maze procedure for AF ranged from 75 percent to 93 percent, depending on the type of AFib and the length of follow-up.

It’s worth noting that the success of the maze procedure will also depend on the skill and experience of the surgical team performing the procedure, as well as the specific technique used, which is why it is so important to choose a team with experience in the procedure. I believe my greatest strength as a heart surgeon is the team of wonderfully talented people that partner with me at Sequoia Hospital to produce the best results that are nationally and internationally recognized in cardiac surgery.

Q: What is recovery like for the maze procedures? Follow-up? How will having the procedure affect patients’  everyday life?

The goal of these surgical procedures is to restore good quality of life, relieve symptoms associated with atrial fibrillation and eliminate the need for anticoagulation and antiarrhythmic medications.

The recovery process after the hybrid maze procedure can vary from patient to patient, but generally, patients can expect to spend one to three days in the hospital after the surgery. During this time, they will be monitored closely for any complications and administered pain medication as needed. The period of recovery for the hybrid procedure is typically two to four weeks In contrast, recovery is typically six to eight weeks for the open-heart procedure.

Patients will need to have regular follow-up appointments with their cardiologist to monitor their progress. In some cases, additional procedures or treatments may be necessary to maintain normal heart rhythm.

Luis Castro Headshot and quote

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