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Comparative Study
. 2012 Feb;5(1):8-14.
doi: 10.1161/CIRCEP.111.963819. Epub 2011 Nov 17.

The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades

Timo Weimar  1 , Stefano Schena, Marci S Bailey, Hersh S Maniar, Richard B Schuessler, James L Cox, Ralph J Damiano Jr
Affiliations
Comparative Study

The cox-maze procedure for lone atrial fibrillation: a single-center experience over 2 decades

Timo Weimar et al. Circ Arrhythm Electrophysiol. 2012 Feb.

Abstract

Background: The Cox-Maze procedure (CMP) has achieved high success rates in the therapy of atrial fibrillation (AF) while becoming progressively less invasive. This report evaluates our experience with the CMP in the treatment of lone AF over 2 decades and compares the original cut-and-sew CMP-III to the ablation-assisted CMP-IV, which uses bipolar radiofrequency and cryoenergy to create the original lesion pattern.

Methods and results: Data were collected prospectively on 212 consecutive patients (mean age, 53.5±10.4 years; 78% male) who underwent a stand-alone CMP from 1992 through 2010. The median duration of preoperative AF was 6 (interquartile range, 2.9-11.5) years, with 48% paroxysmal and 52% persistent or long-standing persistent AF. Univariate analysis with preoperative and perioperative variables used as covariates for the CMP-III (n=112) and the CMP-IV (n=100) was performed. Overall, 30-day mortality was 1.4%, with no intraoperative deaths. Freedom from AF was 93%, and freedom from AF off antiarrhythmics was 82%, at a mean follow-up time of 3.6±3.1 years. Freedom from symptomatic AF at 10 years was 85%. Only 1 late stroke occurred, with 80% of patients not receiving anticoagulation therapy. The less invasive CMP-IV had significantly shorter cross-clamp times (41±13 versus 92±26 minutes; P<0.001) while achieving high success rates, with 90% freedom from AF and 84% freedom from AF off antiarrhythmics at 2 years.

Conclusions: The CMP, although simplified and shortened by alternative energy sources, has excellent results, even with improved follow-up and stricter definition of failure.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr. Damiano is a consultant for AtriCure and Medtronic and has received research grants from AtriCure, Medtronic, and Estech. Dr. Schuessler receives research support from AtriCure, Estech, and Cardialen and serves on the scientific advisory board of Cardialen. Dr. Cox has a financial relationship with SentreHEART and CorMatrix. Dr. Maniar is a consultant for nContact Surgery and Estech. Ms. Bailey is a consultant for AtriCure.

Figures

Figure 1
Figure 1
The original cut and sew Cox-Maze Procedure III.
Figure 2
Figure 2
The right atrial lesion set of the Cox-Maze Procedure IV.
Figure 3
Figure 3
The left atrial lesion set of the Cox-Maze Procedure IV.
Figure 4
Figure 4
Kaplan-Meier (K-M) Analysis of freedom from atrial fibrillation (AF) for the Cox- Maze-Procedure (III+IV). Pts, patients.
See this image and copyright information in PMC

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