Cox-Maze Procedure for Atrial Fibrillation: Mayo Clinic Experience

Schaff, Hartzell V.; Dearani, Joseph A.; Daly, Richard; Orszulak, Thomas A.; Danielson, Gordon K.

doi:10.1016/s1043-0679(00)70014-1

Cited by 223 publications

(100 citation statements)

References 27 publications

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“…In fact, it is the most effective curative therapy for AF yet devised, and these facts must be considered when new ablative approaches to AF are developed. 11,12,26,27 Cox and colleagues [11][12][13][14] designed the procedure on the basis of early experimental and clinical evidence concerning the pathophysiology of AF. To improve results and simplify the operation, they modified the procedure twice, culminating in the Cox-Maze III.…”

Section: The Maze Proceduresmentioning

confidence: 99%

“…In experienced hands, the Maze procedure requires 45 to 60 minutes of cardiopulmonary bypass and cardiac arrest. 14,26,27 The operation may be performed alone or in conjunction with other cardiac surgical procedures, such as mitral valve repair or coronary artery bypass grafting.…”

Section: The Maze Proceduresmentioning

confidence: 99%

“…29 Other centers have documented excellent results with the Maze procedure, with restoration of sinus rhythm in 75% to 95% of patients, low risk of late stroke, and very low operative morbidity and mortality. 26,27 In recent series, the need for a new pacemaker has decreased to 5% to 10%. 30 These results confirm the safety of the Maze procedure, its efficacy at restoring sinus rhythm, and the prevention of late strokes.…”

Section: The Maze Proceduresmentioning

confidence: 99%

“…For them, results with alternate energy sources fall just short of those reported for the classic Maze procedure. 14,26,27 After surgical ablation, perioperative AF is common, occurring in Ϸ50% of patients. 23 Although 30% to 40% of patients leave the hospital in AF, many return to sinus rhythm over the ensuing 3 months.…”

Section: Gillinov Surgical Treatment Of Atrial Fibrillationmentioning

confidence: 99%

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Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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Abstract-Atrial fibrillation (AF) is the most common sustained arrhythmia. It is associated with increased risks of death and stroke; most strokes in AF patients are thought to arise from thrombi in the left atrial appendage. Surgical ablation of AF includes excision of the left atrial appendage and is an effective means of treating this arrhythmia, with the classic Maze procedure curing AF in Ͼ90% of patients and virtually eliminating the risk of late stroke. A complex but safe operation, the Maze procedure has been applied by relatively few surgeons. Americans; this number is expected to increase to Ͼ5.6 million by 2050. 1 The prevalence of AF increases with increasing patient age, and recent data from the Framingham Heart Study suggest that the lifetime risks for development of AF are 1 in 4 for men and women aged Ն40 years. 2 This epidemic has a growing impact on the healthcare system and a multibillion dollar cost. The clinical consequences of AF are well documented. AF is associated with reduced life expectancy and increases the risk of stroke 5-fold, accounting for Ϸ15% of all strokes nationally. 3-8 These AF-related strokes are a major challenge and a focus of several clinical trials investigating strategies for primary and secondary prevention. 4 Currently, antithrombotic therapy is the mainstay for stroke prevention in AF patients.Although there is currently some consensus concerning pharmacological strategies for stroke prevention in AF patients, choice of therapy for the heart rhythm is controversial and evolving. 9,10 Available antiarrhythmic therapies inconsistently restore sinus rhythm and are associated with complications. In fact, the risks associated with antiarrhythmic drug therapy may counterbalance the potential benefit of restoration of sinus rhythm. 9,10 These observations, coupled with increased understanding of the pathogenesis of AF, have resulted in the development of interventional strategies to restore sinus rhythm. Both catheter-based and surgical approaches have demonstrated effectiveness in this regard. Developed by Dr James Cox, the classic Maze procedure is the predicate operation for ablation of AF; long-term data suggest that the Maze procedure eliminates AF in Ͼ90% of patients. 11-14 Despite these unmatched results, the complexity and time associated with the Maze procedure have prevented widespread application by surgeons.Recently, however, there has been increased interest in direct surgical ablation of AF, fueled by technological advances and demonstration that the pulmonary veins and left atrium are the drivers of AF in most patients. 15 New ablation technologies enable surgeons to perform pulmonary vein isolation, create strategically placed, linear left atrial lesions, and excise the left atrial appendage rapidly and safely. 16 -23 Alternate energy sources used to create lines of conduction block and replace surgical incisions of the Maze procedure include radiofrequency, microwave, ultrasound, cryothermy, and laser. 16 -25 Applied primarily in patients with valvular...

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Section: The Maze Proceduresmentioning

confidence: 99%

Section: The Maze Proceduresmentioning

confidence: 99%

Section: The Maze Proceduresmentioning

confidence: 99%

Section: Gillinov Surgical Treatment Of Atrial Fibrillationmentioning

confidence: 99%

See 2 more Smart Citations

Advances in Surgical Treatment of Atrial Fibrillation

Gillinov

2007

Stroke

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“…Over the past few years, several studies [8][9][10][11][12][13] have demonstrated the efficacy of the maze procedure (Table I). Although insufficient numbers of patients have undergone this procedure to demonstrate its true efficacy, the high success rate of the maze procedure so far suggests that it is indeed possible to prevent the perpetuation of AF by compartmentalizing the atria using multiple linear incisions.…”

Section: Surgical Maze Proceduresmentioning

confidence: 99%

Catheter ablation of atrial fibrillation

Camm

2002

Clinical Cardiology

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SummaryFollowing the advent of the surgical maze procedure, several catheter techniques have been developed to provide permanent prophylaxis against atrial fibrillation. These noninvasive techniques work by compartmentalizing the atria, by ablating the arrhythmogenic foci, or by isolating the atria from these foci. Although still at an early stage of development, preliminary results using focal ablation and circumferential ablation show extreme promise.

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Catheter Ablation Therapy for Supraventricular Arrhythmias

Marine

2007

JAMA

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Cox-Maze Procedure for Atrial Fibrillation: Mayo Clinic Experience

Cited by 223 publications

References 27 publications

Advances in Surgical Treatment of Atrial Fibrillation

Advances in Surgical Treatment of Atrial Fibrillation

Catheter ablation of atrial fibrillation

Catheter Ablation Therapy for Supraventricular Arrhythmias

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