136:). After the introduction of the initial procedure, 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." Damiano and colleagues have described a Cox-Maze IV procedure in 2002 in which they modified the Cox-Maze III technique using a combination of bipolar radiofrequency and cryothermal ablation lines. Since then, the Cox-Maze IV procedure is the gold standard surgical treatment for AF with conversion to normal sinus rhythm and freedom from AF at 1 year postoperatively of 93%, but the results are institution dependent.
1220:
131:
The intention was to eliminate AF by using incisional scars to block abnormal electrical circuits (atrial macroreentry) that initiate and perpetuate the abnormal electrical waves of AF. This required an extensive series of full-thickness incisions through the walls of both atria, a median sternotomy
139:
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
161:
Cox J, Schuessler R, D'Agostino H, Stone C, Chang B, Cain M, Corr P, Boineau J (1991). "The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure".
124:
Incidence of stroke in patients with AF who are anticoagulated is still around 2-5% per year. The first such procedure was performed by Dr. Cox at St. Louis' Barnes
Hospital—now
337:"Comparing mid-term outcomes of Cox-Maze procedure and pulmonary vein isolation for atrial fibrillation after concomitant mitral valve surgery: A systematic review"
459:
1168:
494:
590:
110:
40:
988:
578:
144:. Microwave and laser therapy have both been withdrawn from the market, but the other devices continue to be utilized to treat AF surgically.
102:
863:
1113:
789:
694:
994:
198:"The Cox maze III procedure for atrial fibrillation: long-term efficacy in patients undergoing lone versus concomitant procedures"
452:
286:
Henn, MC; Lancaster, TS; Miller, JR; Sinn, LA; Schuessler, RB; Moon, MR; Melby, SJ; Maniar, HS; Damiano RJ, Jr (November 2015).
1001:
808:
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798:
1123:
624:
1108:
1096:
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133:
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1055:
945:
699:
489:
1134:
1118:
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106:
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1072:
972:
937:
783:
141:
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125:
1207:
1011:
932:
1181:
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551:
546:
1060:
1038:
724:
563:
536:
118:
72:
239:"Illustrated techniques for performing the Cox-Maze IV procedure through a right mini-thoracotomy"
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956:
898:
893:
834:
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663:
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87:
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35:
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1158:
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927:
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903:
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670:
499:
484:
196:
Prasad S, Maniar H, Camillo C, Schuessler R, Boineau J, Sundt T, Cox J, Damiano R (2003).
114:
68:
132:(vertical incision through the sternum), and cardiopulmonary bypass (heart-lung machine;
254:
1065:
1050:
846:
823:
654:
638:
573:
418:
393:
361:
336:
312:
287:
263:
238:
83:
214:
197:
174:
1236:
1202:
922:
541:
378:
967:
98:
86:. Today, various methods of minimally invasive maze procedures, collectively named
1144:
887:
851:
531:
516:
303:
1139:
1006:
911:
679:
427:
370:
321:
272:
223:
237:
Robertson, JO; Saint, LL; Leidenfrost, JE; Damiano RJ, Jr (January 2014).
182:
101:
is an
American cardiothoracic surgeon. Cox received his medical degree at
105:
and completed his training in both
General and Cardiothoracic Surgery at
49:
352:
288:"Late outcomes after the Cox maze IV procedure for atrial fibrillation"
409:
335:
Sef, D; Trkulja, V; Raja, SG; Hooper, J; Turina, MI (30 August 2022).
803:
1152:
982:
813:
658:
473:
79:
441:
113:
developed the "maze" or "Cox maze" procedure, an "open-heart"
78:"Maze" refers to the series of incisions arranged in a
1195:
1167:
1024:
879:
775:
515:
508:
34:
26:
21:
292:The Journal of Thoracic and Cardiovascular Surgery
109:. Cox and his associates at Duke, and later at
142:without actually cutting into the atrial walls
453:
8:
394:"Surgical Treatment of Atrial Fibrillation"
512:
495:Cardiology diagnostic tests and procedures
460:
446:
438:
591:Transcatheter pulmonary valve replacement
417:
360:
311:
262:
213:
634:shunt from heart chamber to blood vessel
398:Methodist DeBakey Cardiovascular Journal
111:Washington University School of Medicine
734:shunt from blood vessel to blood vessel
153:
103:University of Tennessee Medical Center
18:
864:Valve-sparing aortic root replacement
603:enlargement of existing septal defect
7:
598:production of septal defect in heart
255:10.3978/j.issn.2225-319X.2013.12.11
45:
695:transposition of the great vessels
620:creation of septal defect in heart
14:
995:Cardiac resynchronization therapy
1219:
1218:
243:Annals of Cardiothoracic Surgery
117:procedure intended to eliminate
1002:Left atrial appendage occlusion
1:
1124:Radionuclide ventriculography
215:10.1016/S0022-5223(03)01287-X
175:10.1016/S0022-5223(19)36684-X
1109:Myocardial perfusion imaging
304:10.1016/j.jtcvs.2015.07.102
1259:
716:for univentricular defect
341:Journal of Cardiac Surgery
134:extracorporeal circulation
1216:
1056:Implantable loop recorder
700:Arterial switch operation
490:Interventional cardiology
480:
298:(5): 1168–76, 1178.e1-2.
46:
1135:Coronary catheterization
625:Blalock–Hanlon procedure
586:Mitral valve replacement
569:Aortic valve replacement
202:J Thorac Cardiovasc Surg
163:J Thorac Cardiovasc Surg
107:Duke University Hospital
1131:Cardiac catheterization
1073:Electrophysiology study
973:Radiofrequency ablation
938:Alcohol septal ablation
1177:Impedance cardiography
799:Coronary artery bypass
126:Barnes-Jewish Hospital
1208:Transcutaneous pacing
1012:Heart transplantation
933:Ventricular reduction
749:Blalock–Taussig shunt
82:-like pattern in the
16:Type of heart surgery
1182:Ballistocardiography
739:systemic circulation
1061:Cardiac stress test
1039:Electrocardiography
978:Pacemaker insertion
725:Kawashima procedure
689:compound procedures
564:Aortic valve repair
537:Mitral valve repair
119:atrial fibrillation
88:minimaze procedures
73:atrial fibrillation
1243:Cardiac procedures
1114:Cardiovascular MRI
1044:Vectorcardiography
899:Pericardial window
894:Pericardiocentesis
835:Drug-eluting stent
664:Rastelli procedure
613:Balloon septostomy
353:10.1111/jocs.16888
61:Cox maze procedure
22:Cox maze procedure
1230:
1229:
1087:Angiocardiography
1033:Electrophysiology
1020:
1019:
963:Catheter ablation
946:Conduction system
871:LeCompte maneuver
859:Bentall procedure
720:Norwood procedure
710:Senning procedure
705:Mustard procedure
608:Atrial septostomy
559:Valve replacement
410:10.14797/VNDG5944
347:(11): 3801–3810.
57:
56:
1250:
1222:
1221:
1187:Cardiotocography
1155:
1119:Ventriculography
1092:Echocardiography
1083:
1035:
951:Maze procedure (
948:
914:
890:
843:
842:Obstacle removal
830:Bare-metal stent
826:
786:
743:pulmonary artery
735:
690:
675:pulmonary artery
648:Fontan procedure
643:pulmonary artery
635:
599:
513:
462:
455:
448:
439:
432:
431:
421:
392:Wolf RK (2021).
389:
383:
382:
364:
332:
326:
325:
315:
283:
277:
276:
266:
234:
228:
227:
217:
193:
187:
186:
158:
63:, also known as
50:edit on Wikidata
19:
1258:
1257:
1253:
1252:
1251:
1249:
1248:
1247:
1233:
1232:
1231:
1226:
1212:
1191:
1163:
1159:Phonocardiogram
1151:
1081:Cardiac imaging
1079:
1031:
1016:
944:
928:Septal myectomy
918:Cardiomyoplasty
910:
904:Pericardiectomy
886:
875:
841:
822:
782:
776:Cardiac vessels
771:
765:Glenn procedure
733:
688:
671:right ventricle
633:
597:
519:
504:
500:Cardiac imaging
485:Cardiac surgery
476:
466:
436:
435:
391:
390:
386:
334:
333:
329:
285:
284:
280:
236:
235:
231:
195:
194:
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155:
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115:cardiac surgery
96:
67:, is a type of
53:
17:
12:
11:
5:
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1234:
1228:
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1217:
1214:
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1211:
1210:
1205:
1199:
1197:
1193:
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1190:
1189:
1184:
1179:
1173:
1171:
1169:Function tests
1165:
1164:
1162:
1161:
1156:
1148:
1147:
1142:
1137:
1128:
1127:
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1116:
1111:
1106:
1105:
1104:
1099:
1089:
1084:
1076:
1075:
1070:
1069:
1068:
1066:Bruce protocol
1058:
1053:
1051:Holter monitor
1048:
1047:
1046:
1036:
1028:
1026:
1022:
1021:
1018:
1017:
1015:
1014:
1009:
1004:
998:
997:
992:
986:
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960:
949:
941:
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935:
930:
925:
920:
915:
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906:
901:
896:
891:
883:
881:
877:
876:
874:
873:
867:
866:
861:
855:
854:
849:
847:Endarterectomy
844:
838:
837:
832:
827:
824:Coronary stent
819:
818:
817:
816:
811:
806:
792:
787:
779:
777:
773:
772:
770:
769:
768:
767:
753:
752:
751:
736:
730:
729:
728:
727:
722:
714:
713:
712:
707:
702:
691:
685:
684:
683:
682:
668:
667:
666:
655:left ventricle
652:
651:
650:
636:
630:
629:
628:
627:
617:
616:
615:
610:
600:
594:
593:
588:
583:
582:
581:
576:
574:Ross procedure
566:
561:
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554:
549:
539:
534:
529:
523:
521:
510:
506:
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502:
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487:
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478:
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472:involving the
467:
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457:
450:
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433:
384:
327:
278:
229:
188:
152:
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95:
92:
65:maze procedure
55:
54:
47:
44:
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38:
32:
31:
30:Maze procedure
28:
24:
23:
15:
13:
10:
9:
6:
4:
3:
2:
1255:
1244:
1241:
1240:
1238:
1225:
1215:
1209:
1206:
1204:
1203:Cardioversion
1201:
1200:
1198:
1194:
1188:
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1178:
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1172:
1170:
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1160:
1157:
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1103:
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1008:
1005:
1003:
1000:
999:
996:
993:
990:
987:
984:
981:
979:
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974:
971:
969:
966:
964:
961:
958:
954:
950:
947:
943:
942:
939:
936:
934:
931:
929:
926:
924:
923:Dor procedure
921:
919:
916:
913:
909:
908:
905:
902:
900:
897:
895:
892:
889:
885:
884:
882:
878:
872:
869:
868:
865:
862:
860:
857:
856:
853:
850:
848:
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840:
839:
836:
833:
831:
828:
825:
821:
820:
815:
812:
810:
807:
805:
802:
801:
800:
796:
793:
791:
788:
785:
781:
780:
778:
774:
766:
763:
762:
761:
758:to the right
757:
754:
750:
747:
746:
744:
740:
737:
732:
731:
726:
723:
721:
718:
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711:
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669:
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632:
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623:
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611:
609:
606:
605:
604:
601:
596:
595:
592:
589:
587:
584:
580:
579:Transcatheter
577:
575:
572:
571:
570:
567:
565:
562:
560:
557:
553:
550:
548:
545:
544:
543:
542:Valvuloplasty
540:
538:
535:
533:
530:
528:
525:
524:
522:
518:
514:
511:
507:
501:
498:
496:
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491:
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486:
483:
482:
479:
475:
471:
463:
458:
456:
451:
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443:
440:
429:
425:
420:
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407:
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368:
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309:
305:
301:
297:
293:
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282:
279:
274:
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265:
260:
256:
252:
249:(1): 105–16.
248:
244:
240:
233:
230:
225:
221:
216:
211:
208:(6): 1822–8.
207:
203:
199:
192:
189:
184:
180:
176:
172:
169:(4): 569–83.
168:
164:
157:
154:
147:
145:
143:
137:
135:
129:
127:
122:
120:
116:
112:
108:
104:
100:
93:
91:
89:
85:
81:
76:
74:
70:
69:heart surgery
66:
62:
51:
42:
39:
37:
33:
29:
25:
20:
991:implantation
985:implantation
968:Cryoablation
952:
809:Off-pump CAB
619:
602:
527:Valve repair
517:Heart valves
404:(1): 56–64.
401:
397:
387:
344:
340:
330:
295:
291:
281:
246:
242:
232:
205:
201:
191:
166:
162:
156:
138:
130:
123:
97:
90:, are used.
77:
64:
60:
58:
1145:Cardiac PET
888:Pericardium
852:Atherectomy
790:Angioplasty
532:Valvulotomy
27:Other names
1140:Cardiac CT
1007:Cardiotomy
912:Myocardium
680:Sano shunt
470:procedures
468:Tests and
148:References
128:—in 1987.
520:and septa
379:251932594
99:James Cox
1237:Category
1224:Category
957:minimaze
953:Cox maze
428:34104322
371:36040710
322:26432719
273:24516807
224:14688693
36:ICD-9-CM
509:Surgery
419:5834122
362:9804989
313:4637220
264:3904342
183:2008095
94:History
1196:Pacing
804:MIDCAB
795:Bypass
745:shunt
639:atrium
552:mitral
547:aortic
426:
416:
377:
369:
359:
320:
310:
271:
261:
222:
181:
121:(AF).
1153:sound
1025:Tests
983:S-ICD
880:Other
814:TECAB
659:aorta
474:heart
375:S2CID
84:atria
48:[
41:37.33
955:and
693:for
424:PMID
367:PMID
318:PMID
269:PMID
220:PMID
179:PMID
80:maze
71:for
59:The
1102:TEE
1097:TTE
989:ICD
784:CHD
756:SVC
741:to
673:to
657:to
641:to
414:PMC
406:doi
357:PMC
349:doi
308:PMC
300:doi
296:150
259:PMC
251:doi
210:doi
206:126
171:doi
167:101
1239::
760:PA
422:.
412:.
402:17
400:.
396:.
373:.
365:.
355:.
345:37
343:.
339:.
316:.
306:.
294:.
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267:.
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245:.
241:.
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204:.
200:.
177:.
165:.
75:.
1133:/
959:)
797:/
461:e
454:t
447:v
430:.
408::
381:.
351::
324:.
302::
275:.
253::
247:3
226:.
212::
185:.
173::
52:]
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