What exactly is the minimaze procedure?
You can read about the minimaze procedures here.
Which of these are most commonly done, and why?
Patients undergoing surgery at Sacred Heart Medical Center in Eugene, Oregon will undergo the Wolf MiniMaze procedure, with additional attention to determination of conduction block and elimination of the ganglionated plexi. The latter is an addition to the procedure that is expected to improve success. Patients undergoing surgery elsewhere should discuss the exact procedure with their physician.
Why the Wolf MiniMaze procedure?
We've been performing curative procedures for AF here since 1998; it is thought that the first catheter ablation in the Pacific Northwest was performed here. We re-evaluated the options in 2004 and chose the Wolf MiniMaze as the best of the available procedures. The main advantage of the Wolf MiniMaze over other minimaze procedures is that accurate testing of conduction block and elimination of autonomic ganglionated plexi can be done convincingly and thoroughly, under direct visualization. These are thought to be the main targets for successful elimination of atrial fibrillation.
What are some things I can do before surgery to build up strength?
If you smoke, you should stop. Eat a well balanced diet including fruits, vegetables, foods high in protein and supplement with a multivitamin.
What problems should I expect with this procedure?
As with any surgery or general anesthesia you are at risk for unplanned problems. These should be discussed with your physician prior to surgery. Experiencing atrial fibrillation during the first 8 weeks or so after surgery is not uncommon and if you haven’t planned on that can feel disappointing. When you recognize it as a common phase of the healing process, and that it is likely to resolve after the first 8 weeks, you may feel better about it.
What can I expect the first few days after surgery?
Each institution perfoming this procedure may manage aspects somewhat differently. Generally, after surgery you will go to the recovery room until you are awake enough to go to the Cardiac Stepdown Unit (CSU). Rarely, you will go to the Intensive Care Unit (ICU) instead. You will most likely experience some discomfort when you use your spirometry, deep breath & cough, to assist in expanding your lungs after having anesthesia. Sleeping might be challenging just because it may be difficult to get comfortable. You will get up and walk soon after surgery and while you are in the hospital.
What is the expected length of time for recovery?
Each patient is unique regarding recovery. You should not expect a rapid return of high energy or the ability to return to normal activities in the first two weeks. The first week after leaving the hospital, it is common to enjoy walking and activities that require minimal lifting, pulling or stretching. Patients have described an "ache" in their shoulders, back or either side of their chest, as opposed to a “pain”. Patients have expressed that a heating pad relieves this ache. This tends to resolve within several weeks of surgery.
What medications will I be taking after the surgery? Will they be long term or short term?
While you are in the hospital you will most likely be on anticoagulation (warfarin and low molecular weight heparin (LHWH)), aspirin, prednisone, and the anti-arrhythmic medication you were on prior to surgery. The medications you will be given may vary depending on your individual needs. After you are discharged, the prednisone is tapered off. The antiarrhythmic is continued for a period, perhaps three months. At that point the continued need for these medications is reviewed and antiarrhythmics usually stopped. There is no consensus on the long-term need for warfarin (Coumadin) so this will depend on your circumstances and your physician.
How soon will I be medically released to drive?
With a few things considered you may be driving as soon as two weeks post operatively. If you are still taking pain medication at two weeks it is recommended you delay driving.