Maze III replication using radiofrequency microbipolar coagulation

The major concerns about the Cox's Maze III procedure have been the long bypass and cross-clamp times involved. We have developed a technique using microbipolar coagulation to duplicate most of the incisions described in the Maze III procedure.

This procedure is performed using standard hypothermic cardiopulmonary bypass and cold sanguineous hyperkalemic arrest. The left atrial Maze is performed using microbipolar coagulation following repair or following valve excision, prior to replacement. Cryolesions are used instead of radiofrequency at the mitral annulus to avoid injury to the circumflex coronary artery. Valve replacement is then done and the left atriotomies are closed. After rewarming, adequate deairing and removal of the aortic cross-clamp, the right atrial procedure is performed using microbipolar coagulation except ends of the radiofrequency lesion lines at the tricuspid annulus, where cryolesions are used. The rest of the surgery proceeds as usual. We used this procedure concomitantly with valve surgery in 84 patients. Sinus rhythm was restored in 86% of them.

The use of radiofrequency energy in the microbipolar mode is safe and effective. The technique is easily reproducible and the tools involved are inexpensive and readily available. Although the cure rate is less compared to Cox's Maze III procedure and there is an attrition rate, sinus rhythm and atrial mechanical function is restored in the majority and with brief additional operative time.