Posted by Henry Alken on November 25, 2001 at 18:33:21:
In order to add to the important information submitted by Dave, Carl and Jack, I would like to add this description of a recent Maze surgery performed on a (nameless) patient by a well known (nameless) surgeon at a (nameless) hospital. I hope this description will add to the volume of useful information already contained on this Maze-Alumni message board.
Preoperative Diagnosis: Symptomatic paroxysmal atrial fibrillation.
Postoperative Diagnosis: Symptomatic paroxysmal atrial fibrillation.
Procedure: Minimally invasive maze procedure.
Anesthesia:
Indications for Surgery: This is a 69-year-old man who had several years of paroxysmal atrial fibrillation. He has failed medical therapy. He had two syncopal episodes in approximately the past month. He also had attempted catheter ablation of atrial fibrillation that was unsuccessful. The maze procedure was discussed with the patient, who understood and agreed to proceed.
Operative Findings: Through the minimally invasive incision, exposure was good. There were no abnormalities of the heart and great vessels, there was no thrombus.
Operative Procedure: The patient was prepped and draped in the usual fashion. A primary lower sternotomy was made. Heparin was given and the patient was cannulated with an arterial cannula in the ascending aorta, a right angle cannula in the superior vena cava and the percutaneous right femoral vein cannula. Bypass was established and the patient was kept normothermic. The aortic crossclamp was applied and the aortic root was infused with cold blood cardioplegia. In addition, retrograde cardioplegia was given intermittently. The left atrium was opened in the intra-atrial groove, the inferior right atrium was opened from the AV groove to the lateral right atrium. The septum was opened to the tendon of Todaro. The inferior incision was brought to the left inferior pulmonary vein. The usual incision across the dome was used to excise the left atrial appendage, then connected to the previous incision. The usual left inferior atriotomy was brought to the mitral valve annulus. Cryolesions were placed at the mitral valve annulus, outside the coronary sinus and inside the coronary sinus, each at -60 degrees C for two minutes. The left atrial incisions were all closed with running #3-0 Prolene. The aortic crossclamp was removed after 56 minutes. The usual incision across the free wall in the right atrium was brought to the right atrial appendage, and then medially to the tricuspid valve annulus. The inferior right atriotomy was brought to the tricuspid annulus. Cryolesions were placed at the two locations on the tricuspid valve annulus, up the superior vena cava and from the inferior vena cava over to the coronary sinus. All incisions were closed with #3-0 Prolene. The patient was then easily weaned from bypass with satisfactory hemodynarnics. Protamine was given and the cannulae were removed in the usual fashion. Pacing wires and chest tubes were placed. When we were satisfied with hemostasis, the sternum was closed with interrupted wire, and the remainder of the incisions were closed in the usual fashion. The patient was transferred to the intensive care unit in satisfactory condition.