Cox maze procedure
Encyclopedia
The Cox maze procedure is a type of heart surgery
for atrial fibrillation
.
"Maze" refers to the series of incisions arranged in a maze
-like pattern in the atria. Today, various methods of minimally invasive maze procedures, collectively named minimaze procedures, are used.
, MD, and associates developed the "maze" or "Cox maze" procedure, an "open-heart" cardiac surgery
procedure intended to eliminate atrial fibrillation
(AF), and performed the first one at St. Louis' Barnes Hospital—now Barnes-Jewish Hospital
-- in 1987. The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that AF requires. This required an extensive series of full-thickness incisions through the walls of both atria, a median sternotomy (vertical incision through the sternum) and cardiopulmonary bypass (heart-lung machine; extracorporeal circulation). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard" for effective surgical cure of AF. It was quite successful in eliminating AF, but had drawbacks as well. The Cox maze III is sometimes referred to as the "Traditional maze", the "cut and sew maze", or simply the "maze".
During the past 10 years, several energy sources such as unipolar radiofrequency, bipolar radiofrequency, microwave, laser, high-intensity focused ultrasound, and cryothermia were incorporated into various devices in order to create some of the lesions of the Cox Maze-III procedure without actually cutting into the atrial walls. Microwave and Laser therapy have both been withdrawn from the market but the other devices continue to be utilized to treat atrial fibrillation surgically. Most of them, however, are used to create lesion patterns that are not as extensive as those of the Cox Maze-III procedure and have not proven to be as successful. Whether the failures when using these devices are due to a failure of the energy source or to the fact that an incomplete lesion set was employed remains an unresolved matter.
Cardiac surgery
Cardiovascular surgery is surgery on the heart or great vessels performed by cardiac surgeons. Frequently, it is done to treat complications of ischemic heart disease , correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart...
for atrial fibrillation
Atrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
.
"Maze" refers to the series of incisions arranged in a maze
Maze
A maze is a tour puzzle in the form of a complex branching passage through which the solver must find a route. In everyday speech, both maze and labyrinth denote a complex and confusing series of pathways, but technically the maze is distinguished from the labyrinth, as the labyrinth has a single...
-like pattern in the atria. Today, various methods of minimally invasive maze procedures, collectively named minimaze procedures, are used.
History
James CoxJames L. Cox
James L. Cox, MD, is an American cardiothoracic surgeon and medical innovator best known for the development of the Cox maze procedure for treatment of atrial fibrillation.- Early background :...
, MD, and associates developed the "maze" or "Cox maze" procedure, an "open-heart" cardiac surgery
Cardiac surgery
Cardiovascular surgery is surgery on the heart or great vessels performed by cardiac surgeons. Frequently, it is done to treat complications of ischemic heart disease , correct congenital heart disease, or treat valvular heart disease from various causes including endocarditis, rheumatic heart...
procedure intended to eliminate atrial fibrillation
Atrial fibrillation
Atrial fibrillation is the most common cardiac arrhythmia . It is a common cause of irregular heart beat, identified clinically by taking a pulse. Chaotic electrical activity in the two upper chambers of the heart result in the muscle fibrillating , instead of achieving coordinated contraction...
(AF), and performed the first one at St. Louis' Barnes Hospital—now Barnes-Jewish Hospital
Barnes-Jewish Hospital
Barnes-Jewish Hospital is the largest hospital in the U.S. state of Missouri. It is the adult teaching hospital for Washington University School of Medicine, and is located in St. Louis, Missouri. It is consistently rated one of the top hospitals in the United States by U.S. News & World Report...
-- in 1987. The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that AF requires. This required an extensive series of full-thickness incisions through the walls of both atria, a median sternotomy (vertical incision through the sternum) and cardiopulmonary bypass (heart-lung machine; extracorporeal circulation). A series of improvements were made, culminating in 1992 in the Cox maze III procedure, which is now considered to be the "gold standard" for effective surgical cure of AF. It was quite successful in eliminating AF, but had drawbacks as well. The Cox maze III is sometimes referred to as the "Traditional maze", the "cut and sew maze", or simply the "maze".
During the past 10 years, several energy sources such as unipolar radiofrequency, bipolar radiofrequency, microwave, laser, high-intensity focused ultrasound, and cryothermia were incorporated into various devices in order to create some of the lesions of the Cox Maze-III procedure without actually cutting into the atrial walls. Microwave and Laser therapy have both been withdrawn from the market but the other devices continue to be utilized to treat atrial fibrillation surgically. Most of them, however, are used to create lesion patterns that are not as extensive as those of the Cox Maze-III procedure and have not proven to be as successful. Whether the failures when using these devices are due to a failure of the energy source or to the fact that an incomplete lesion set was employed remains an unresolved matter.