Aortic valve replacement with maze procedure

I have more testing coming up but it I was told that I will need an aortic valve replacement. Since I also have afib I have been told that the surgeon would perform an ablation at the same time. I will have to have open heart surgery. Has anyone else heard of this? I was hoping to have Dr. Natale perform the ablation when I felt the time had come for that. I am worried that I don't have the best surgeon for the ablation. The only place I have for help and info is on the internet. I am so anxious since I got this news,certainly doesn't help with my afib. I ended up going to the ER for afib a week ago.

I'm a little confused. You mention a Maze procedure in the title but then say it's going to be an ablation. Those are two are very different things, and surgeons don't usually do ablations. However, they do do Maze procedures.

If your surgeon wants to do a Maze while he's in there, it makes sense to do it then, but the question you need to ask is do you want a Maze procedure at all? Just because he can do a Maze doesn't mean that's the right choice for you. Maze procedures should never be a first choice for the treatment of afib. It's very common to end up with atrial flutter after a Maze, which then requires an ablation to deal with that. I think you should consider the valve and afib two separate decisions that likely don't have the same solution.

You have a bicuspid aortic valve, right? That's why he says it has to be open heart?

Yes bicuspid valve. I really dont know the difference between maze or ablation. I was told that he does maze procedure when I asked about an ablation. I am so confused now. Really don't know what to do. Should I do the ablation first or AVR?



Edited 1 time(s). Last edit at 09/19/2019 06:50PM by amyorca.

A Maze procedure is done from the outside of the heart, which is why they're done by surgeons rather than EPs. It's the same basic idea but instead of burning lines on the inside of the heart with heat, they cut lines on the outside with a scalpel. Personally, I'm no fan of Maze procedures and wouldn't choose one as a first or second choice. The chances are very good you'll end up with flutter afterwards and need an ablation anyway.

As for which to do first, I'd say do the valve first. It's the more important procedure, and also the much bigger one that will take months to reach full recovery, so get that out of the way first. It's also a good idea to do that first because sometimes valve replacement can cause afib. But if you want Natale to do the ablation, I would call his office and talk to them about this. I would imagine he'll have some input for you.

Thanks Carey, that makes sense. I was in contact with Dr. Natale's office last year. Was waiting until I had better health insurance as they wouldn t pay him. Now I am on Medicare advantage. I think it is a good idea to talk to them. Thanks for the suggestion.

A friend of mines mother had a MAZE procedure done and had successful outcome.

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rocketritch
A friend of mines mother had a MAZE procedure done and had successful outcome.

Sure, lots of people have, but it's a big procedure and it has drawbacks. Probably the number one drawback is you're likely to end up needing an ablation anyway to fix the flutter that the Maze procedure produced. Doesn't happen to everyone, but the incidence is very high.

Carey said:

"It's the same basic idea but instead of burning lines on the inside of the heart with heat, they cut lines on the outside with a scalpel."

I was thinking that a full blown open Heart Maze involved cutting completely through Atria in multiple places, and then sewing it up immediately afterward. That's was why it is so successful. Or maybe that was the old way of doing it.

Here's a question.
Regardless of which procedure you choose, if you're having open heart surgery, can/should the LAA be removed or sewn shut while they're in there?
I know I'd want that.



Edited 3 time(s). Last edit at 09/20/2019 09:58AM by Mac.

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Mac
Here's a question.
Regardless of which procedure you choose, if you're having open heart surgery, can/should the LAA be removed or sewn shut while they're in there?
I know I'd want that.

Yes, definitely. Surgeons have been removing and/or suturing the LAA closed during heart surgery as a matter of routine for many years, but it's something I would mention to the surgeon to make sure he does. Doing that will reduce stroke risk as well as anticoagulants do.

Can you please explain what the LAA is? I've heard it referred to on here but not sure what it is. I am also wondering If my afib is because of the bicuspid valve, does that mean that it will stop once I have the valve replacement? Or has afib over the past 5 years created too much damage? I seem to have many PACS which I had for several years before afib struck. Even so, I am lucky that on average in have 2 big episodes a year which convert on their own. The longest I've been in afib in around 12 hrs. Thank you for your help, I need as much information as I can get.

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Carey
As for which to do first, I'd say do the valve first. It's the more important procedure, and also the much bigger one that will take months to reach full recovery, so get that out of the way first. It's also a good idea to do that first because sometimes valve replacement can cause afib. But if you want Natale to do the ablation, I would call his office and talk to them about this. I would imagine he'll have some input for you.

I was in a similar position: all set with Natale for an ablation when a new echo showed severe mitral regurgitation. Natale’s office said to get the valve fixed first—there were very clear about it.

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amyorca
Can you please explain what the LAA is?

The LAA (left atrial appendage) is a pouch-like structure that hangs off the side of your left atrium. It is where 90% of all afib-related clots form. This happens because during afib, your atria aren't pumping effectively, so blood can pool and stagnate in the LAA causing clots to form. Closing or removing the LAA has no negative health consequences, so it's fairly standard procedure to remove it or suture it closed during open heart surgery. Doing so reduces your risk of stroke by 90%, or to about the same level as people who don't have afib. Since it has no negative health consequences, it makes sense to close or remove it during heart surgery.

There are also devices that can be implanted via catheter to close the LAA. I have one known as a Watchman that was implanted by Drs. Horton and Natale, as do a couple of other people here. But since you're going to undergo open heart surgery anyway, just having the surgeon close it during that procedure makes more sense for you.

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I am also wondering If my afib is because of the bicuspid valve, does that mean that it will stop once I have the valve replacement?

Nobody can tell you if one caused the other, but I doubt the afib will stop when the valve is replaced. It's not that your afib has done so much damage. It's simply that afib is a progressive disease and doesn't usually get better on its own. Replacing valves can even cause it, as I mentioned earlier, so it's very unlikely to cure it. If it does, hurray!, but I wouldn't count on it.

Hi Daisy, Are you going to have open heart surgery? Or is it something you can have done non invasively?
Carey, how did they place the watchman in there? How long ago did they do it? How are you doing with it?
I appreciate so much any help. I am so anxious and really just need to know what is happening, what choices I should make and how they are going affect my quality of life. I am a very physically active and independant person. I hope that I will still be after all this. The next thing is the TEE and cardiac catherization which I am quite afraid of death or stroke after receiving my instructions today. Yikes!

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amyorca
Hi Daisy, Are you going to have open heart surgery? Or is it something you can have done non invasively?
Carey, how did they place the watchman in there? How long ago did they do it? How are you doing with it?

Daisy's already had her valve replacement and it didn't require open heart.

A Watchman is placed with a catheter, just like in an ablation. A catheter is inserted into your femoral vein, threaded up into the right atrium, then through the septum, and into the left atrium where the LAA is. The catheter is positioned in the opening of the LAA, and the Watchman is expanded to hold itself in place. You can search for Watchman on youtube and find all sorts of videos explaining it. I had it done in August 2018 and I'm doing fine with it. It's not something one is even aware of having.

But this is all beside the point for you. Since you need open heart surgery anyway, closing or removing your LAA then is the way to go.

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The next thing is the TEE and cardiac catherization which I am quite afraid of death or stroke after receiving my instructions today. Yikes!

It's a very safe procedure. They have to list ALL the possible complications, so you see all sorts of scary stuff. I really wish they would give actual numbers on those things instead of leading patients to think stroke and death and such happen commonly. They don't. They're exceedingly rare. There's no reason to be afraid of a catheterization.

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amyorca
Hi Daisy, Are you going to have open heart surgery? Or is it something you can have done non invasively?

As Carey said, mine was done in June. It wasn’t non-invasive, but much less invasive than open heart surgery. I got a “new part” via a catheter though initially it looked like I’d need open heart surgery. The cardio thoracic surgeon I consulted with at Cedars Sinai recommended this instead of open heart. When they were thinking open heart it would have been robotically done which means that they don’t open the breastbone, but rather make a four inch incision under the right breast.

I just started cardiac rehab and from what I’ve experienced so far I think you would do well to ask for it if they don’t routinely offer it. Everyone I’ve talked to there says that it brought them great improvements. Good luck with this! I know how scary it can be.

Thanks Carey and Daisy!

Today at rehab I met a woman who had had open heart surgery to replace a valve. She was doing really well and said how much the rehab program had helped her. I don’t know what choices you will have but she had gone with a bovine valve and it is working well. Keep us updated.

I'll definitely ask for cardiac rehab. Still not sure what kind of valve the surgeon will recommend, but I would like to avoid a mechanical one if I can.