How to spread out the satisfactory exposure: placement technique in right-sided maze procedure

We have, whenever possible, substituted cryoablation for incisions in the maze procedure. Cryoablation helps prevent massive bleeding because the number of resuturing sites is reduced and aortic cross-clamp time decreased. We are careful not to injure the atrio-ventricular conduction system during incision at the side of the Koch triangle or cryoablation while manipulating the atrial septum. In prior versions of the right-sided maze procedure, the IVC return cannula has obstructed the surgical field approaching the IVC and the tricuspid valve annulus. This report describes a new modification of maze procedure that includes changing the venous return site. We have obtained a satisfactory surgical field without being afraid of the anatomical pitfall, between the appendage and the tricuspid valve, and between the right coronary artery and the extended T incision. We studied 12 patients (8 males and 4 females, mean age 61 years) who underwent the maze procedure. Sinus rhythm was restored in 11 patients, whose clinical condition was improved to NYHA class I status. This technique has proven effective in obtaining satisfactory exposure of the-right atrium during the maze procedure.