The Cox-Maze III Procedure
Dr. James Cox developed the Cox Maze procedure in 1987. This surgery is rarely done due to the technical difficulty and complexity of the procedure, as well as the associated possible complications. New innovative techniques have been developed which are as effective as the Cox-Maze procedure, but much less difficult to perform. The Cox-Maze has proven to be a very successful curative treatment with studies showing 98% of patients had no recurrence of atrial fibrillation after an average of 5 years. 1 2
How the surgery is done This surgery is performed during an open-heart procedure while on the heart-lung bypass machine and when the heart has been arrested (stopped beating). The surgeon makes specific incisions along the right and left atrium which are then sewn back up, creating a “maze”. Once all of the incisions have healed, they form scar tissue. The scar tissue re-routes the electrical impulses through this “maze” forcing them to travel along the proper pathways and eliminating the ability for these abnormal signals to cause irregular heart rhythms.
Although the Cox-Maze procedure has shown to be highly effective in curing atrial fibrillation, it is highly invasive and can be associated with significant complications when performed alone. However, if the Cox-Maze is performed in addition to another cardiac surgery procedure, for example a mitral valve repair, it is not associated with any higher mortality or complication rate than that of the valve repair alone. It is also a time consuming and technically difficult procedure and because of this, relatively few surgeons are skilled to perform this procedure. 2
2 Damiano, Ralph J., et al. The long-term outcome of patients with coronary disease and atrial fibrillation undergoing the Cox maze procedure. Journal of Thoracic and Cardiovascular Surgery 2003; 126: 2016-2021.
12 Marjan, J, Graeme, W, Mandal, K, et al. Current Strategies in the Management of Atrial Fibrillation. Annals of Thoracic Surgery 2006; 82: 357-364. |