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Cox-Maze Procedure—Atrial Fibrillation


The Cox-Maze procedure was developed to treat and cure atrial fibrillation (A-fib). This is important for several reasons. Restoration of A-V synchrony improves LV systolic function, especially in the setting of poor left-ventricular function. Return to sinus rhythm lowers the risk of stroke, eliminating clot formation within the left atrium. Additionally, patients may be free from requiring lifelong medications such as anti-arrhythmics and anticoagulants. 

The Cox-Maze procedure (“cut-and-sew”) can be successful in more than90% of cases, but is rarely performed due to its complexity and technical challenges. A series of complex cuts are performed along known macro re-entrant pathways of both left and right atria. These surgical cuts permanently divide and redirect the atrial wiring, eliminating the propagation of fibrillation and restoring a path for normal sinus conduction. This remains the most successful, reliable, and effective procedure to treat A-fib in the setting of complex valvular and ischemic heart disease. A 2003 study at Washington University in St. Louis showed a greater than 95% cure rate 10 years after a Cox-Maze procedure. 

At Sequoia Hospital, the surgical team has vast experience, having performed more than 400 successful “cut-and-sew” Cox-Maze procedures. Our overall mortality rate for this procedure is 1.5%. Since 1998, we have had zero mortality in our mitral-valve repair population; the mortality rate remains at zero when adding a full cut-and-sew Cox-Maze procedure in patients with associated A-fib. 

In patients with isolated A-fib, we are now incorporating minimally invasive methods to generate identical Cox-Maze cut-and-sew lesions in both the right and left atria. This extremely effective approach is performed througha mini right thoracotomy and does not depend on further hybrid-type strategies and “touch up” ablations. Until now, patients who have failed multiple catheter-based A-fib ablations and continue to have refractory arrhythmias, or who have not been able to tolerate drug therapy, have had very few, if any, good options. As a result, in patients with no other heart ailment besides A-fib, our less invasive surgical approach offers them the very best chance for a long term cure.

Cox-Maze Procedure Patient Case Study


Patient History


Complex Cox-Maze Procedure


When Results Matter