Related Experiment Video
Updated: Jun 27, 2026
Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
Published on: February 26, 2013
Cox-maze III procedure for atrial fibrillation during valve surgery: a single institution experience
Chang-Tian Wang1, Lei Zhang2, Tao Qin2
1Department of Cardiovascular Surgery. Jinling Hospital, Nanjing University, School Medicine, 305 East Zhongshan Road, Nanjing, 210002, PR China. wangct35037@163.com.
Insights
The Cox-Maze III procedure effectively treats atrial fibrillation (AF) in heart valve disease patients, restoring sinus rhythm in over 90% of cases with low mortality.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia in patients with heart valve disease.
- Surgical intervention for valve disease presents an opportunity to address concomitant AF.
Purpose of the Study:
- To evaluate the efficacy and safety of the Cox-Maze III procedure combined with valve surgery.
- To assess the long-term sinus rhythm maintenance after the combined procedure.
Main Methods:
- Retrospective analysis of 66 patients undergoing Cox-Maze III and valve surgery (Oct 2015 - June 2019).
- Utilized monopolar radiofrequency ablation alongside traditional cut-and-sew techniques for AF treatment.
Main Results:
- Overall hospital mortality was 3.0%.
- Sinus rhythm was maintained in 91.7% at 1 month, reaching 89.5% at 24 months.
- Low rates of permanent pacemaker implantation (4.5%), reoperation for bleeding (1.5%), renal failure (4.5%), and no strokes were reported.
Conclusions:
- The Cox-Maze III procedure is a safe and effective surgical option for AF in patients with heart valve disease.
- The combined approach demonstrates high rates of sinus rhythm restoration and acceptable morbidity/mortality.
Objectives:
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia in patients with heart valve disease. Our aim was to summarize our experience and evaluate the efficacy and safety of the Cox maze III procedure combined with valve surgery in patients with AF.
Methods:
A retrospective, observational analysis was performed for all consecutive patients underwent maze III procedure combined with valve surgery between October 2015 and June 2019. In this trial, we used a monopolar radiofrequency (RF) ablation in addition to cut and sew technique to treat AF.
Results:
66 patients (37 female, 56.1%) with persistent or long-lasting persistent AF associated with valve disease were identified. The mean age was 54.2 ± 8.4 years (range, 30 to 73 years). Overall hospital mortality was 3.0%. The duration of cardiopulmonary bypass and aortic cross clamping was 175.4 ± 32.9 and 115.6 ± 22.8 min respectively. The first 24 h drainage was 488.6 ± 293.3 ml. The postoperative hospital stay was 14.8 ± 8.3 days. The postoperative incidence of permanent pacemaker implantation, reoperation for bleeding, renal failure required hemodialysis, and stroke was 4.5, 1.5, 4.5% and 0 respectively. The frequency of sinus rhythm was 91.7, 93.1, 94.7, 93.3 and 89.5% at 1, 3, 6, 12, and 24 months respectively.
Conclusions:
The Cox-Maze III procedure is safe in the surgical treatment of AF associated with valve disease, and efficacious for sinus rhythm maintenance, with low morbidity and mortality.
