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Atrial Fibrillation and a Catastrophic Mini-Maze Surgery

By Lorrie C., August 2020

Lorrie C.

The first part of Lorrie’s Atrial Fibrillation story was written in 2012 from her hospital room upon re-admission after Mini-Maze surgery. She then jumps to the present and writes about the aftermath.

As I sit in my hospital bed on my seventh consecutive day of my second admission, I have finally mustered the strength and clarity of mind to write about my exasperating experience of an elective surgery.

My A-Fib Gets Worse

My A-Fib started approximately 10 years ago when I was in my early 60’s with only a few episodes a year.

The story of my Mini-Maze surgery began about four years later when my electrophysiologist felt it was time to put an end to my increasing episodes of Atrial Fibrillation. (Atrial fibrillation, or A-Fib, is an irregular heart rhythm caused by the quivering of heart muscles of the atria.)

Years ago, many physicians regarded A-Fib as “just a nuisance.” It is now known that clots form during an episode and may cause a stroke when the patient returns to a normal sinus rhythm.

As one grows older, the A-Fib episodes can become more frequent and stretch the atria. Once it stretches beyond the criteria for surgical correction, there is nothing more that can be done, and the patient may eventually suffer from persistent A-Fib and simply have to live with the feeling of “squirrels in the chest.”

Catheter Ablation or Mini-Maze?

Due to having paroxysmal A-Fib (meaning every now and then for unknown reasons) as well as my good health and stamina, at 66 years of age I was the perfect candidate for either a catheter vein ablation or Mini-Maze surgery. Because I was only having about 3 episodes a year and in good health, my EP felt that I would have a success rate of over 95%.

With both the catheter ablation and the Mini-Maze, the electrophysiologist or cardiothoracic surgeon creates lesions by cauterizing around the pulmonary veins to hopefully stop [interrupt] the erratic electrical signals which cause A-Fib.

After much research, I decided the Mini-Maze would be the best procedure for me. (My EP felt it would be a better choice than an ablation, for he felt I would have a good outcome which I did not.)

About Mini-Maze Surgery

As I understand it, three incisions are made under the arm on each side of the chest.  The lungs are somewhat deflated, and the surgeon has a clear view of the heart to see exactly where the lesions are being made.

My EP told me he would be there to do mapping. (Whether he was for sure or not, I do not know. I can only assume he was.) [It is not standard practice for an EP to be present during a Mini-Maze surgery.]

One advantage of the Mini-Maze over a catheter ablation is that the left atrial appendage, where most clots form, is stapled off thereby reducing the risk of stroke by 80%.

For more about the Mini-Maze, see my article:“When to consider a Mini-Maze surgery instead of a Catheter Ablation?” 

Warned that Mini-Maze Won’t be a “Walk in the Park”

My electrophysiologist agreed with my decision, although he warned me that the Mini-Maze wouldn’t be a “walk in the park.” That was an understatement!

I chose a well-known cardiothoracic surgeon from a very well-known hospital to perform my surgery and hopefully end my A-Fib forever.

Interviewing the Surgeon―Many Questions

My daughter, Lisa, accompanied me to my initial visit, and we were both armed with questions. When I asked the surgeon, what were the risks of the surgery, he said the two major risks were phrenic nerve damage or bleeding.

We questioned him vigorously, and he was very patient answering all questions. He said I would be “in and out of A-Fib” for the first two or three months due to inflammation. I am sorry to say the one thing we didn’t ask was what complications could be encountered during or after the surgery.

To be sure I was making the right decision, I met with the surgeon a second time and drilled him again. He said his success rate was 80%; however, I would most probably be in the 90% and above bracket.

Selecting a cardiac specialist can be a daunting task, to learn how, see our page: Finding the Right Doctor for You and Your A-Fib.

The Day of My Mini-Maze Surgery Arrives

My Mini-Maze was performed on September 1, 2012, at one of the top 100 hospitals in the country with one of the best cardiothoracic surgeons at the helm. Contrary to what my electrophysiologist had warned, I was confident this surgery would be a “walk in the park.”

The surgery took approximately 4 ½ hours. My husband and my friend anxiously awaited the results from the surgeon. He told them my surgery went perfectly, and that I was doing very well.

My Recovery―Three Days in the Hospital

I spent the first day in the Intensive Care Unit on heavy duty pain meds as well as a nerve block, so I don’t remember much the first couple of days.

I vaguely remember the surgeon telling me I developed fluid around the outside of my right lung, but it would probably be absorbed. If not, I would have to come back to the hospital to have a drain tube inserted and stay overnight.

On the third day after the surgery, I had an eight-hour episode of A-Fib (which was to be expected).

I was discharged on the sixth day and was delighted to be home again.

Back Home, but Daily A-Fib Episodes―Breathing Problems

Much to my disappointment, I began to experience daily A-Fib episodes lasting anywhere from eight hours up to twenty hours. I knew this was to be expected, but it could not be happening to me―after all, I am Super Woman!

My breathing began to worsen, and I had to move my post op visit up a week.

After a chest x-ray and exam, the surgeon told me I had to be re-admitted to the hospital.

Post-Surgery Visit Sooner Than Planned

After having a chest x-ray and an examination, the surgeon told me I had to be admitted the next day to have a drain tube inserted – the fluid around my right lung was not being absorbed and had to be drained.

The fluid was causing a pneumothorax (collapsing of the lung) and that was the reason I was so short of breath. (Complication #1)

Re-Admitted to Hospital

Drainage Tube Inserted: I was admitted to the hospital and the chest tube was inserted…but without anesthetic. And let me tell you, it was the most painful experience next to childbirth!  (Complication #2) That evening, a CT scan of the chest was done to see if there was proper placement of the drain tube. The CT revealed something that I was not prepared for….

Undisclosed Fractured Rib: The next morning, my husband and I were taken aback when the surgeon told us he had fractured a rib during the surgery and he had removed a portion of the middle of my rib, then stitched muscle in place to fill the gap.

…and a Lung Hernia: He explained that after surgery, my excessive coughing tore those stitches. I now had a hernia that had to be surgically repaired as soon as the lung surgeon was available. (The hernia was my lung popping out of the space where the piece of rib had been removed!)  (Complication #3)

Fortunately, when the lung surgeon viewed my CT and examined me, he didn’t feel emergency surgery was necessary, for he said it was a small hernia and it may repair itself. [If not, and it became worse or bothered me, he could do the repair, but it was not an emergency.

My overnight stay became a week due to going in and out of A-Fib.

Overnight Stretches to a Week in the Hospital: My overnight stay became a week due to going in and out of A-Fib. I was on Coumadin and waiting for my INR to be at a therapeutic level so I can be discharged.

Home, Sweet Home

Cellulitis from Infected IV: It has been difficult writing this saga in long hand, for I have developed cellulitis [red, swollen, bacterial skin infection] in my right hand from an infected IV.  (Complication #4)

…and a Respiratory Tract Infection: I am now at home, still coughing away. It’s due to an upper respiratory tract infection I caught the first couple of days in the hospital. (Complication #5)

Thankfully, the cellulitis is much improved, and I am able to type my story as I am going in and out of A-Fib.”

Fast-Forward to 2020: The After-Path of a Catastrophic Surgery

Today, I have no A-Fib episodes. I still go into atrial tachycardia [the atria beats too quickly] and have frequent PVC’s [extra heartbeats from a ventricle] and bradycardia.[slower than normal heart rate].

No doctor has said anything about my lung hernia. I assume once you have one, it will always be there unless you have surgery.

Another result of my mini-maze was paralyzed diaphragm [from surgical trauma, causes reduction in lung capacity]. I still have some shortness of breath from the paralyzed diaphragm “but it’s something I can live with.”

When I was in A-Fib before, I was very symptomatic. I dread the time, if I discontinue amiodarone, that my A-Fib will return.

That, along with my right lung being raised above my left lung. It was not like that before the surgery and the surgeon could not explain why.

I still take a low dose of amiodarone (200 mg). I do know the dangers of amiodarone, and I do have had some thyroid issues. But my EP and cardiologist monitor my labs for the effects and feel the low dose is okay for me.

Lessons learned about life with A-FibLesson Learned

My advice to other A-Fib patients? Due your homework. Get second opinions.

About choosing a Mini-Maze vs Ablation? Listen to the advice of your doctor, but always get a second opinion.

Make sure the surgeon has done a lot of this type of surgery. My surgeon was a prominent, skilled heart surgeon, but I don’t believe he had much experience in performing the mini-maze. (At the time this surgery was not yet popular in my geographical area.)

And finally, if you are going to have any type of surgery, please ask your surgeon what “complications” you may encounter, not just the risks.

Thank you for reading!
Lorrie C.

Editor's Comments about Cecelia's A-Fib storyEditor’s Comments

Lorrie was an informed patient. She did everything right.
To find A-Fib specialists in your area or country, see A-Fib.com Directory of Doctors and Facilities 
She researched her disease, she studied the surgical treatments. She thoughtfully chose to have a Mini-Maze surgery. She chose a highly skilled cardiac surgeon with an outstanding reputation. She and a companion interviewed the surgeon and asked loads of questions—twice. And chose one of the top 100 hospitals in the country for her surgery. It’s a shame she had to endure so many complications.
I Don’t Understand: Why didn’t the surgeon tell Lorrie’s family that he had fractured and perforated her rib during the Mini-Maze? That’s a long-term complication that could affect Lorrie for years and cause major, lasting pain.
It’s hard to comprehend why on her re-admission, the surgeon used no anesthetic when he inserted the drainage tube into Lorrie’s chest. It’s also unusual for Lorrie to have so many A-Fib attacks right after her Mini-Maze.  
Caution: Mini-Maze Not Recommended for First Timers. In general, catheter ablation is recognized in current guidelines as a first option treatment for A-Fib (Class IIa). Whereas surgical treatments such as the Mini-Maze are generally not a first option (Class IIb), (The exception is special circumstances such as intolerance to anticoagulants.)
I admit it! I’m biased toward catheter ablation for the majority of A-Fib patients.

It’s less traumatic and you are often home the same day or the day after. And it can be repeated, if needed.

Mini-Maze Surgery has Limitations: The standard Mini-Maze only isolates the Pulmonary Veins (PVs). If you have A-Fib signals coming from other parts of the heart untreatable by a Mini-Maze (such as Flutter from the right atrium), you’ll need a catheter ablation with advanced mapping to find and isolate these A-Fib spots.
Is Mini-Maze Really “Minimally Invasive”? To the average patient, a Mini-Maze is still heart surgery with the potential risks and complications. On the upside, more surgeons now are accessing the heart less invasively through the diaphragm rather than through the ribs as in Lorrie’s case. But it’s still not a “walk in the park.”
Ablation vs. Mini-Maze Trial: There are few clinical trials comparing the Mini-Maze to Catheter Ablation. One was the SCALAF trial which found that patients undergoing the Mini-Maze had nearly a one-in-four chance of having a major complication (unacceptable for most patients). To learn more, see my article: Catheter Ablation vs Surgery For A-Fib: Finally an Apples-to-Apples Comparison.  
Controversy about Removal of Left Atrial Appendage (LAA): Lori mentioned that the Mini-Maze surgery includes removal of the LAA. The LAA is not a useless appendage. Some medical professionals question the need of removing the LAA if the goal of the surgery is to no longer be in A-Fib. To learn more, see my article: The Role of the Left Atrial Appendage (LAA) & Removal Issues.
Dangers of Long-term Amiodarone: While Amiodarone is the most effective of the antiarrhythmic drugs, it’s also the most toxic. Normally people are on Amiodarone for only a few months or less. To learn more see: Amiodarone: Most Effective and Most Toxic. And especially this tragic, heartbreaking story of a doctor who died on Amiodarone: Toxic Effects of Amiodarone—What Could Have Prevented this Death?
Thank you, Lorrie! We are grateful to Lorrie for sharing her cautionary tale about the possible complications of Mini-Maze surgery.

Learn about sharing your A-Fib story

Return to: Personal A-Fib Stories

If you find any errors on this page, email us. Y Last updated: Saturday, August 22, 2020

 

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