Related Experiment Video
Updated: Nov 24, 2025
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
The Impact of the Cox-Maze Technique on Freedom From Atrial Fibrillation
Edgar Aranda-Michel1, Derek Serna-Gallegos1, Arman Kilic1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Comparing surgical ablation techniques for atrial fibrillation (AF) after cardiac surgery, this study found no significant long-term differences in mortality or AF recurrence between the cut-and-sew Maze (CAS) and cryoablation/bipolar Maze (CB) methods.
Area of Science:
- Cardiovascular Surgery
- Cardiac Electrophysiology
- Arrhythmia Management
Background:
- Atrial fibrillation (AF) is the most prevalent arrhythmia complicating cardiac surgery.
- Two primary surgical ablation techniques exist: cut-and-sew Maze (CAS) and cryoablation/bipolar Maze (CB).
- Limited comparative data exist regarding the long-term efficacy of CAS versus CB.
Purpose of the Study:
- To compare the long-term outcomes of CAS and CB surgical ablation techniques for atrial fibrillation.
- To evaluate differences in mortality, pacemaker implantation, and AF recurrence between the two Maze procedures.
Main Methods:
- A retrospective study included 482 patients undergoing concomitant cardiac surgery and Maze ablation (2011-2018).
- Patients were divided into CAS (n=287) and CB (n=198) groups.
- Long-term outcomes, including mortality and AF recurrence, were analyzed using Kaplan-Meier curves and competing-risk regression.
Main Results:
- Long-term mortality was similar between CAS and CB groups (22.3% vs 17.4%, P=.91).
- There were no significant differences in pacemaker implantation rates (11.1% vs 11.3%, P=.813) or freedom from AF recurrence (73.3% vs 78.2%, P=.294).
- NYHA class IV, aortic valve replacement, and concomitant CABG+valve were independent predictors of AF recurrence; Maze type was not.
Conclusions:
- The study demonstrates no significant difference in long-term freedom from atrial fibrillation between CAS and CB surgical ablation techniques.
- Both CAS and CB appear to be appropriate options for surgical AF treatment, with technique choice potentially guided by surgeon expertise and patient factors.
Background:
Atrial fibrillation (AF) is the most common arrhythmia observed with concomitant cardiac surgery. Surgical options include a cut-and-sew technique Maze (CAS) and a cryoablation/bipolar technique Maze (CB). There are limited data comparing the long-term outcomes of these 2 techniques.
Methods:
All patients who underwent either CAS or CB Maze between 2011 and 2018 were included in the study. Chi-square test and Fisher's exact test or Student's t test were used to compare differences between baseline characteristics. Kaplan-Meier survival curves were generated for each group. Cumulative incidence functions were generated for AF recurrence and Fine-Gray competing-risk regression was used to determine predictors for AF recurrence.
Results:
A total of 482 patients underwent open surgical ablation. Of those, 287 had CAS and 198 had CB. All procedures were concomitant with cardiac surgery. There was similar long-term mortality between the CAS and CB cohorts (22.3% vs 17.4%; log-rank P = .91). There was no difference in pacemaker implantation (11.1% vs 11.3%; P = .813) or long-term freedom from AF recurrence (73.3% vs 78.2%; P = .294). On Fine-Gray competing-risk regression, New York Heart Association functional class IV (hazard ratio [HR], 2.07; P = .03), concomitant aortic valve replacement (HR, 3.02; P = .01), and concomitant CABG + valve (HR, 2.36; P = .02) were significant independent predictors for AF recurrence; Maze type was not a predictor.
Conclusions:
These data indicate no difference between the CAS vs CB with respect to freedom from long-term AF. Both techniques may be appropriate based on surgeon experience and patient characteristics.
