What to Expect After Mini-Maze Surgery
If you're having Mini-Maze surgical ablation, what should you expect afterwards based on the experiences of other Mini-Maze patients?
In the Hospital
After surgery, you may be in the intensive care unit (ICU) anywhere from a few hours to a day or more, where you are monitored very closely. Even after moving to a regular hospital room, expect to be hooked up to monitors so that the nursing staff can monitor your heart rate and blood pressure, and know how you are doing at all times. You may have other tests run as well to check your heart and lungs.
At your side may be a device that lets you self-administer pain medication. Some patients specifically mentioned using the pain medication, but our founder, Mellanie, recalls that the hospital staff kept asking her why she never used it. She was so out of it from the anesthesia that she didn't feel the pain, but felt reassured that the pain medication was there if needed.
To help you recover, you may be given a spirometer to use for breathing exercises to help keep fluid out of the lungs. Mellanie was still under intense anesthesia when they brought the spirometer, and if they told her how to use it, she doesn't remember. Reading through the information at this link before your surgery and knowing how to use the spirometer could shorten your hospitalization and hasten your recovery.
Once you leave the ICU and get settled into a normal hospital room, you'll start gradually walking. When the nurse told Mellanie "we're going for a walk around the nurse's station with a walker, and I'll help you", she wondered why she would need help. She soon learned just how wobbly she was, though she now realizes that the wobbliness was mostly due to anesthesia that didn't go away for a week.
After the procedure, you will go back on antiarrhythmic medication and anticoagulants (warfarin or Coumadin®) for up to several months, which may vary from center to center. Some patients were on their medications for as little as 30 days and others for 3–6 months or longer. You may, or may not, receive a diuretic to reduce fluid retention.
You'll go home in 2–4 days. One patient we spoke with was discharged after 2 days because the next day was a holiday, but in retrospect felt that he would have done better if he had stayed another day. Mellanie was in the hospital for 3 days, but might have gone home sooner had it not been for the "anesthesia hangover."
When compared to a week or more in the hospital with an open-chest Maze surgical ablation, this is significantly better. The recovery time is much shorter, too, and the risks are significantly less as well.
Problems Experienced
While Mini-Maze surgery is minimally-invasive compared to open heart surgery, it is still surgery, involving anesthesia, pain, soreness, tubes, recovery time, and risks. Some of the risks mentioned earlier include collapsed lung, vein inflammation (phlebitis), heart tissue inflammation (pericarditis), and blood vessel or heart damage. 1
None of the Mini-Maze patients we've interviewed have experienced any of these serious issues, but some did experience milder problems. Here are some of the things they experienced:
- Chest tightness, soreness, pain, tenderness, and occasional swelling.
- Coughing or difficulty breathing at first, which resolved by doing breathing exercises with a spirometer to keep fluid out of the lungs.
- Unusual heart rhythms — most were afib-free after surgery, but some experienced arrhythmias, such as slow or rapid heart rates or irregular heartbeats, which soon resolved. It isn't unusual for 30%–50% to experience skipped heartbeats or short afib episodes in the first three months due to swelling of atrial tissue.
- Pain and irritation from drainage tubes was a common complaint — these tubes are placed in the chest following surgery to drain fluid from around the heart and lungs, and it's very uncomfortable to have them removed.
- Nausea or feeling hung over from the anesthesia.
- Fluid retention — one patient went home from the hospital ten pounds heavier, and the clothes worn to the hospital no longer fit several days later. It might be worth having loose clothes to wear home, and to wear for a week or two afterwards. This may not impact some patients.
Though this list could be a little scary, most of these things are insignificant compared to the after-effects of open-heart surgery.
A small percentage of patients may also experience sensitivity to anesthesia, as Mellanie did. The first night it left her extremely nauseated, and she felt hung over for a week. Even though the amount of anesthesia was carefully calculated based on weight and body size, she received far too much, but has since learned that she's so sensitive to it that a half-dose is just right.
It's common for a small percentage of Mini-Maze surgery patients to require a pacemaker afterwards, but this wasn't reported by any of the patients we interviewed. The percentage seems to vary from center to center, and study results we've reviewed seem to vary by energy source used as well, though it's still too early to tell. Find out the pacemaker numbers for your surgeon.
Post-Surgery Follow Up
Expect to follow up with your doctor or surgeon — which one may vary depending on the institution where you had your surgery and whether your surgery was local or out-of-town — about a week after surgery, and again a few weeks later. Asking lots of questions in advance may help you make sure that the handoff from your surgeon to your cardiologist or primary care physician is as seamless as possible.
At your follow up visit, you may have an EKG or other tests to see how your heart is doing and ensure that the afib is resolved. Expect to have EKGs at 3–6 month increments over the first year, and annually after that.
In addition, you'll be asked to wear an event monitor for a few weeks to record any abnormal heart events. If things look good after wearing an event monitor, then your medications may be discontinued.
Getting Back to Normal
Most Mini-Maze patients we spoke with were back to walking and exercising within a few days, though regaining energy and muscle mass took time. Most were back at work within a few days to two weeks after surgery. One went back to work 2 days after leaving the hospital, but felt that was too soon and hindered recovery.
Over time, for most the incisions healed and left only tiny scars, as shown on the drawing. Having these small scars is a very tiny price to pay for peace of mind that comes from a surgery that can cure your atrial fibrillation and eliminate your blood clot and stroke risk.
Mini-Maze Scars
Image courtesy of AtriCure, Inc.
All of the Mini-Maze patients we've talked with are still atrial fibrillation-free, as much as two years and more since surgery, though most have had some minor incidents since surgery. Mellanie has had one afib incident, but that was when she received an anesthesia from a dentist that revved her heart up and brought on atrial fibrillation. Fortunately, medication resolved it within a few hours.
One patient mentioned that he has a slower heart response to a "load", such as starting up stairs, but when the heart catches up, everything is fine.
The great news for you is that, unlike patients we have interviewed, you don't have to endure a decade or two of atrial fibrillation while waiting for a cure.
And if you are younger than most patients we interviewed, Mini-Maze surgery may be easier on you and your body. And as surgeons perfect the procedure, incisions are becoming smaller.
If you're a female interested in Mini-Maze surgery, see For Women Having Mini-Maze Surgery.
1 Surgical Ablation for Atrial Fibrillation" <http://www.afibfacts.com/Treatment_Options _for_Atrial_Fibrillation/Surgical_Ablation_for_Atrial_Fibrillation/>, AfibFacts.com [Internet], Copyright, 2007.
