Simple But Effective Modifications to the Cox Maze Procedure Using Only Cryoablation

We describe an effective and practical approach for concomitant ablation that we use in 100% of mitral surgery patients with a history of atrial fibrillation. There are 3 steps. First the left atrial appendage is closed with a Clip with is highly effective and electrically isolates it. Second, 3 cryoablation lines are used to recreate the key Cox-Maze III lesion set with a total of 8 minutes of ablation time. In some patients, usually with tricuspid regurgitation, 3 right atrial ablations are placed within 6 minutes of ablation time. The procedure added 10.5 minutes and 13.4 minutes of cross clamp and bypass times. For patients with 3-minute box lesion freezes, 12-month freedom from atrial fibrillation off anti-arrthymics was 90%. There was no increase in peri-operative complications and late survival was the same as mitral patients without AF and a matched population.