A minimally invasive cox-maze procedure: Operative technique and results

Objective: The Cox-Maze procedure (CMP) for the surgical treatment of atrial fibrillation (AF) traditionally has required a median sternotomy and cardiopulmonary bypass. This study describes a method using ablation technologies to create the full Cox-Maze lesion set through a 5-to 6-cm right minithoracotomy. Methods: Twenty-two consecutive patients underwent a CMP through a right mini-thoracotomy and cardiopulmonary bypass. All patients were followed prospectively with electrocardiogram and 24-hour Holter monitoring at 3, 6, and 12 months. The CMP lesion set was created using bipolar radiofrequency energy and cryotherapy. Results: There was no operative mortality or major complications. Two patients required a permanent pacemaker. Five patients (23%) had early atrial tachyarrhythmias. At last follow-up (mean, 18 ± 12 months), all the patients (n = 22) were free from atrial dysrhythmias. At 3 months (n = 19), 84% of patients were off antiarrhythmic drugs. At 6 months (n = 18), 94% of patients were free from AF and off antiarrhythmic medications. At 12 months (n = 16), 81% of patients were free from AF and off antiarrhythmic drugs and three patients remained on warfarin for a mechanical mitral valve. Conclusions: A full CMP can be performed through a right mini-thoracotomy with outstanding short-term results. This less invasive procedure can be offered to patients without compromising efficacy.