33266 Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (eg, maze procedure), without cardiopulmonary bypass

Name of the Procedure:

Endoscopy, surgical; operative tissue ablation and reconstruction of atria, extensive (e.g., maze procedure), without cardiopulmonary bypass. Common name: Maze Procedure (Epicardial Approach)

Summary

In layman's terms, this is a heart surgery that uses small incisions and special instruments to create a "maze" of new electrical pathways in the heart to treat atrial fibrillation, a common type of irregular heartbeat. This version of the procedure does not require stopping the heart or using a heart-lung machine.

Purpose

The maze procedure addresses atrial fibrillation (AFib), a condition where the heart beats irregularly, which can lead to stroke and other complications. The goals are to restore normal heart rhythm and improve the patient's quality of life by preventing AFib-related symptoms such as palpitations, fatigue, and shortness of breath.

Indications

• Persistent or long-standing atrial fibrillation not managed with medication or other less invasive procedures.
• Patients who are not candidates for catheter ablation.
• Failure of previous AFib treatments.

Preparation

• Patients may need to fast (no food or drink) for 8-12 hours before the surgery.
• Blood tests, EKG, echocardiogram, or other diagnostic imaging may be required.
• Adjustments to current medications, especially blood thinners, may be needed.
• Preoperative instructions regarding hygiene and hospital admission details will be provided.

Procedure Description

1. The patient is given general anesthesia to ensure they are asleep and pain-free.
2. Several small incisions are made in the chest.
3. Special endoscopic instruments are inserted through these incisions to reach the heart.
4. Using these instruments, the surgeon creates a series of precise cuts or ablations in the atrial tissue.
5. These cuts form a "maze" that traps and redirects the electrical impulses, allowing the heart to beat normally.
6. No cardiopulmonary bypass is required, meaning the heart continues to beat throughout the procedure.
7. The incisions are closed with sutures or staples.

Duration

The procedure typically lasts between 2 to 4 hours.

Setting

This procedure is usually performed in a hospital operating room equipped with advanced surgical and imaging technology.

Personnel

• Cardiothoracic Surgeon
• Anesthesiologist
• Surgical Nurses
• Possibly a Cardiologist for intraoperative consultation

Risks and Complications

• Infection
• Bleeding
• Blood clots leading to stroke or other complications
• Heart rhythm problems (arrhythmias)
• Injury to surrounding organs
• Rarely, the need for a permanent pacemaker

Benefits

• Restoration of normal heart rhythm
• Reduction in AFib symptoms
• Improved quality of life and exercise capacity
• Reduced risk of stroke and other AFib-related complications
• Benefits may be realized within a few days to a few weeks post-surgery.

Recovery

• Hospital stay typically ranges from 3 to 7 days post-procedure.
• Pain management includes medications.
• Patients are advised to avoid heavy lifting and strenuous activity for several weeks.
• Follow-up appointments with the cardiologist and surgeon to monitor recovery.
• Blood thinner therapy may be resumed to prevent clots.
• Gradual return to normal activities as advised by the healthcare providers.

Alternatives

• Medication management (antiarrhythmic drugs)
• Catheter ablation (less invasive but may be less effective for some patients)
• Electrical cardioversion (temporary solution)
• Left atrial appendage closure devices (in specific patients for stroke prevention)

Patient Experience

• During the procedure, the patient is under general anesthesia and will not feel pain.
• Post-procedure, patients might experience soreness at the incision sites.
• Pain management strategies, including oral painkillers, are provided.
• Patients may feel tired and may need time to regain their usual energy levels.
• Close monitoring and support from the healthcare team ensure a smooth recovery process.