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Diario Oficial de la Sociedad Mexicana de Cirugía Cardiaca, A.C., y del Colegio Mexicano de Cirugía Cardiovascular y Torácica, A.C.

2023, Number 2

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Cir Card Mex 2023; 8 (2)

Confusion surrounding the Cox-maze procedure: a lack of standardization in daily practice

García-Villarreal OA

Language: English
References: 5
Page: 60-60
PDF size: 187.41 Kb.


ABSTRACT

I have carefully read the article by Mehaffey et al., which addresses the various reasons why the surgical ablation (SA) for atrial fibrillation (AF) is currently underused during mitral valve surgery. The authors must be congratulated for this interesting work. However, beyond these true barriers that prevent the implementation of the concomitant SA for AF in daily practice, we must analyze the true causes that have given rise to this situation. Firstly, we must recognize that the only procedure that has proven to be highly effective in eliminating AF in the long term is the Cox-maze procedure (CMP), which remains as the gold standard for SA of AF. The CMP has been painstakingly described by Dr. Cox as a full bi-atrial lesion pattern procedure. All lesser procedures arising from the original CMP are associated with high failure rates after operation and should be avoided.


REFERENCES

  1. Mehaffey JH, Charles EJ, BerensM, Clark MJ, Bond C, Fonner CE, et al. Barriers toAtrial Fibrillation Ablation During Mitral Valve Surgery. J Thorac Cardiovasc Surg(2021). DOI:https://doi.org/10.1016/j.jtcvs.2021.03.039.

  2. Cox JL, Churyla A, Malaisrie SC, Kruse J, Pham DT, Kislitsina ON, et al. When Is aMaze Procedure a Maze Procedure? Can J Cardiol 2018;34:1482-1491. doi: 10.1016/j.cjca.2018.05.008.

  3. Ad N, Damiano RJ Jr, Badhwar V, Calkins H, La Meir M, Nitta T, et al. Expert consensusguidelines: Examining surgical ablation for atrial fibrillation. J Thorac CardiovascSurg. 2017;153:1330-1354.e1. doi: 10.1016/j.jtcvs.2017.02.027.

  4. Je HG, Shuman DJ, Ad N. A systematic review of minimally invasive surgical treatmentfor atrial fibrillation: a comparison of the Cox-Maze procedure, beating-heartepicardial ablation, and the hybrid procedure on safety and efficacy. Eur J CardiothoracSurg. 2015;48:531-540; discussion 540-541. doi: 10.1093/ejcts/ezu536.

  5. Badhwar V, Rankin JS, Damiano RJ Jr, Gillinov AM, Bakaeen FG, Edgerton JR, et al.The Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the SurgicalTreatment of Atrial Fibrillation. Ann Thorac Surg. 2017;103:329-341. doi: 10.1016/j.athoracsur.2016.10.076.




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