Maze procedure for occasional tachycardia at the same time as my mitral valv repair?

[Ricardo]

I was told in July with that I need a mitral valve repair, which is scheduled for mid Dec. First I had to decide between having it performed frontally or less invasive from the right side. Leaning for the less invasive approach as I hate to have my breastbone cut if not necessary--although I want the best repair of course. Since my diagnosis I've had a few incidences or tachycardia, likely stemming from the leaky valve, and have benn wearing the King of Hearts incident recording devise. One surgeon I went to for a third opinion recommended having a "maze procedure" where some cuts are made in the atria, creating sort of a maze for the electrical current to pass through, in hopes of regulating the flutter or whatever it may be. However, my cardiologist says he can't determine whether I have afib or some other condition, or whether it might just go away after the valve repair. Does anyone know about this? Somewhere I heard that approx. 30% of mitral valve repair patients have afib after tyhe surgery. The surgeon who wants to perform the valve repair frontally recommends that I have it done at the same time, with an even larger incision, says that it can't be done from the side. The surgeon who recommends doing the valve repair from the side, says that in the past six months new, longer instruments have come out which allow him to perform the maze procedure at the same time he's repairing the valve from the side, and that he's comfortable doing it that way at the same time. Dilemma is a) whether to also have the maze procedure done at the same time-although it has not been established whether I have afib or not and I do not know the success rates or side effects of that procedure, and b) if I should allow it to be done from the side even though there's less track record, and c) whether to wait and just get the valve repaired and see if the tachycardia just goes away on its own--which may mean a second surgery or ablation later on. Anyone heard of a electrophysiology study? Lots of questions, but not much sleep... Thanks to anyone who may shed some light.

 

[Ross]

Man that's alot to consider. Personally, I'd want a rock solid diagnosis of afib before I'd even think of having the maze done. The maze itself is no guarantee that it will do the job intended to be done. I would think the 30% (of mitral or any heart surgery for that matter) statistic is conservative. Seems like just about everyone in here has or have had, a bout of afib after surgery, with some of those being chronic.

There are others more versed in this then I am. I'll let them address it better, since I vaguely understand the procedure myself. All I know for sure is that your facing about as tough a decision as it gets. I certainly would not want to see you have a second surgery nor would I like to see you have the procedure done if not absolutely necessary. Guess I'll join you in the luny bin on this one.

 

[geebee]

My gut feeling is to give the surgeon the best possible viewing area to be able to fix things. I do not believe that is as good with the side incision. Also, if 2 procedures are to be done, access would be key - for me. Just my two cents.

If doing the maze procedure does not carry any additional risks (I have not done much research despite being in constant a-fib), you might as well have it done and hope it solves the problem. Even if you don't have a-fib now, there is a chance post-surgery and maybe the maze would prevent it (or cure it if that is what you have now). I am not sure why your doctor cannot tell if your irregularities are a-fib, tho. Is that because he has not "caught" any of them on an EKG strip? A-fib is very apparent on a strip so I am a bit confused about that one.

Talk to the nurses at the hospital you want to go to. They always know the best surgeons. You might be able to decide from that type of research.

 

[bouteloa]

MVR and Maze

MVR and Maze

I had my mitral valve repaired AND had the Maze Procedure. Although I didn't have Atrial Fib before my operation, my experience with a friend who went into A-Fib after mitral valve repair made me willing to have the operation. He (friend) had to make major changes in his lifestyle and looked wan for a long time after his surgery.

My logic was that if I was going to be opened up, I was willing to get the Maze repair, too. I searched for the best local surgeon - and left the methodology up to him. Since I had a very bad valve, he opted for the full sternotomy.

At 14 months later, I have no a-fib and and do not take any cardiac drugs. I have stayed in sinus rhythm and pretty much live as though I have no heart troubles at all.

It seems like waiting from July til December is a looooong time to anticipate your surgery. I had only one month and felt anxious often during that time. Glad to get it over with.

I don't get the impression that your surgeon has done all that many, if any, repairs and Maze procedures with the longer tools. This would bother me.

There is a forum of people who have undergone the Maze procedure:

http://www.mddietofutah.com/maze/index.html

And some websites (google for more):

http://members.aol.com/mazern/mazefaq.htm

http://www.sts.org/doc/4512

 

[JeffO]

I had afib

I had afib

Ricardo,

A couple of thoughts...

As Ross said, afib is pretty common after surgery. Most people on here seem to have a "bout" or two with it. But it is a temporary problem for the vast majority of patients.

I was fine when they let me out of the hospital and developed afib at about day 9. Not a bout, but afib all the time. It took me by surprise because I had NO symptoms, just a funny EKG. Once I knew I had it, I could tell the rhythm wasn't right by listening with a stethoscope.

I went on coumadin and upped the dose of Coreg, the beta-blocker I was already on. The afib didn't go away after several weeks, so I signed up for a cardioversion, which corrected the afib and it hasn't been back.

I think I saw someone on VR.com talking recently about some sort of ablation of the left atrial sinus (?? something like that) which is being done sometimes as a preventive measure for afib.

As for the minimally invasive procedure, here's an August 2004 article from the Boston Globe about my surgeon, Dr. Ralph de la Torre, who's done lots and lots of them: http://www.boston.com/business/tech...e146_heart_operations_cut_patients146_trauma/

Best regards,

Jeff

 

[joanne6]

minimally invasive surgery

minimally invasive surgery

Hi, Ricardo
I had mitral valve repair in August done from the right with the minimally invasive approach. I did not want my chest cracked if it was not necessary. Many doctors have been using this approach for a number of years. The answer is you must have a doctor and team in the OR who do this all the time. You do not want someone who is learning. I don't know your doc. Just be sure he is experienced and has done several hundred before he does yours.
The pain level is probably the same but in different places. The rate of infection is supposed to be less. I am not sorry and the valve was repaired beautifully according to all who have seen the ECHO's. The doc who did my surgery explained that approaching the valve from the right is like "looking down the barrel of a gun". They can see directly into the valve. There is a link on their website showing the actual procedure. University of Maryland Health System-open heart surgery site-Dr. James Gammie.
Good luck.
Joanne