Cox-Maze Precedure: Evolution and Clinical Implications

Atrial fibrillation is the most comon arrhythmia in worldwide. Stroke risk in AF is 5-fold higher than sinus rhythm. The left atrial appendage is the most important source of atrial emboli. The standard surgical “cut-and-sew” Cox-maze III procedure is the golden choice for surgical treatment of any type of atrial fibrillation, with success rate higher than 90%. A full bi-atrial lesion pattern must be performed in the Cox-maze procedure. Left atrial appendage removal is included in all Cox-maze procedure. Alternative energy sources emerged as alternative for simplyfing the original Cox-maze procedure. However, success rate has not been as effective as with the original Cox-maze III procedure. Pulmonary vein isolation alone is not enough to treat chronic or persistent atrial fibrillation. Thoracoscopic techniques as well as catheter-based techniques are not able to get complete success in cases of mitral valve disease and atrial fibrillation and must keep away from these pull of patients.