A Minimally Invasive Cox-Maze Procedure Operative Technique and Results

Lee, Anson M.; Clark, Kal; Bailey, Marci S.; Aziz, Abdulhameed; Schuessler, Richard B.; Damiano, Ralph J.

doi:10.1097/imi.0b013e3181ee3815

Cited by 21 publications

(14 citation statements)

References 41 publications

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“…The CMP-IV has significantly decreased cardiopulmonary bypass time as well as major complication rates when compared to our prior experience with the CMP-III. Moreover, with current technology, the procedure can be performed with a minimal invasive approach via a right minithoracotomy without compromising its efficacy [22]. This simplified procedure also makes it easier for a larger number of surgeons to adapt to this technique.…”

Section: Discussionmentioning

confidence: 99%

“…The lower success rate in patients that did not receive a complete box lesion set has lead to an underestimate of the true success rate of the currently performed CMP-IV technique. The development of a minimally invasive approach via a right minithoracotomy had no influence on the lesion set or the success rate [22]. However, cryoablation was more extensively applied in these cases.…”

Section: Discussionmentioning

confidence: 99%

“…Patient underwent either a median sternotomy ( n =79) or a right minithoracotomy ( n =21) [22]. All patients underwent intraoperative transesophageal echocardiography, and cardioversion was performed when needed after the presence of a left atrial appendage clot was excluded.…”

Section: Methodsmentioning

confidence: 99%

“…Cryoablation was used to connect the isthmus ablation line to the mitral annulus. In patients undergoing a right minithoracotomy, cryoablation was more extensively applied to complete the posterior left atrial isolation and the left atrial appendage was oversewn from the inside [22]. …”

Section: Methodsmentioning

confidence: 99%

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The Cox-maze IV procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients

Weimar

Bailey

Watanabe

et al. 2011

J Interv Card Electrophysiol

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106

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Purpose The Cox-maze III procedure (CMP) has achieved high success rates for the surgical treatment of atrial fibrillation (AF). In 2002, our group introduced a simplified CMP, in which most incisions were replaced with linear lines of ablation using bipolar radiofrequency and cryoenergy. This operation, termed the CMP-IV, has significantly shortened operative times and allowed for a minimally invasive approach. This report evaluates our results in 100 consecutive patients undergoing a stand-alone CMP-IV. Methods Data were collected prospectively on 100 patients (mean age, 56±10 years) who underwent a CMP-IV from January 2002 through May 2010. All patients were available for follow-up with a mean follow-up of 17±10 months. Electrocardiograms or 24-h Holter monitorings were obtained at 6, 12, and 24 months. Data were analyzed using a longitudinal database containing over 380 variables. Results Thirty-one percent of patients had paroxysmal AF, with the remainder having persistent (6%) or longstanding persistent AF (63%). The mean preoperative duration of AF was 7.4±6.7 years. The mean left atrial diameter was 4.7±1.1 cm. In this group, 40 patients had failed with a mean of 2.6±1.3 catheter ablations. Mean aortic cross-clamp time was 41±13 min. There was one postoperative mortality. Postoperative freedom from AF was 93%, 90%, and 90% at 6, 12, and 24 months, respectively. Freedom from AF off antiarrhythmic medication was 82%, 82%, and 84% at 6, 12, and 24 months, respectively. Conclusion The less invasive CMP-IV has a high single procedure success rate, even with improved follow-up and stricter definitions of failure.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

The Cox-maze IV procedure for lone atrial fibrillation: a single center experience in 100 consecutive patients

Weimar

Bailey

Watanabe

et al. 2011

J Interv Card Electrophysiol

Self Cite

106

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“…Early results using this approach have been promising when compared to the CMIV performed through a sternotomy. 28 More recent unpublished data has shown freedom from AF off antiarrhythmic drugs was not significantly different between the two groups at 1 and 2 year postoperatively. Furthermore, patients who underwent RMT had fewer complications, and both decreased ICU and hospital lengths of stay when compared to those patients who underwent a CMIV through a sternotomy.…”

Section: Surgical Results: Cox-maze IV Proceduresmentioning

confidence: 82%

Surgery for Atrial Fibrillation

2014

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Synopsis Atrial fibrillation is the most common cardiac arrhythmia and its treatment options include drug therapy or, catheter-based or surgical interventions. The surgical treatment of atrial fibrillation has undergone multiple evolutions over the last several decades. The Cox-Maze procedure which was developed by James Cox in 1987 is a procedure where multiple surgical incisions are created along the atria to interrupt the electrical pathways thought to allow atrial fibrillation to persist. This procedure went on to become the gold standard for the surgical treatment of atrial fibrillation and is currently in its 4th iteration called the Cox-Maze IV. The Cox-Maze IV replaced the previous “cut-and-sew” method with a combination of cryoablation and bipolar RF ablation. The adaption of ablation technologies allowed the Cox-Maze IV procedure to be performed through a less invasive right minithoracotomy instead of a traditional sternotomy approach. The aim of this article is to review the indications and preoperative planning for performing a Cox-Maze IV procedure. A description of the operative techniques for both a sternotomy and right mini-thoracotomy approach will be discussed in addition to specific postoperative considerations. Finally, this article will review the literature describing the surgical results for both approaches including comparisons of the Cox-Maze IV to the previous “cut-and-sew” method.

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