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Cox-Maze For Atrial Fibrillation

The Cox-Maze procedure is the gold standard for treating atrial fibrillation. It was developed at our hospital, and the Washington University doctors we partner with continue to create less invasive techniques for performing the procedure.

We can now complete the Cox-Maze without the need for an open chest incision. Patients from around the world come to our center for the Cox-Maze procedure, because of our skilled doctors, extensive experience and minimally invasive techniques.

Cox-Maze Procedure: Why Choose Us?

Patients choose the Washington University and Barnes-Jewish Heart & Vascular Center when they need a Cox-Maze because of our experience performing the complex procedure and our history of innovation.

We provide:

  • Expert care: We are nationally and internationally recognized as leaders in the Cox-Maze procedure. Other centers often send us patients who have complex atrial fibrillation or atrial fibrillation combined with another heart disorder. We have the resources and skills to care for the most difficult cases. In addition, physicians from around the world come to train with our experts to learn how to perform this complex procedure.
  • Excellent outcomes: Thanks to our experience and high number of procedures, more than 90 percent of our patients see their atrial fibrillation stopped and symptoms relieved with the Cox-Maze. The Cox-Maze procedure is seen as the gold standard for treating atrial fibrillation with the greatest long-term success. We continually refine and improve our technique to offer you the most effective, safest procedure possible.
  • Comprehensive services: Our nurses, intensivists (critical care specialists) and support staff have specialized training and extensive experience with the Cox-Maze procedure. This background enables our team to give you individualized, comprehensive postoperative care to aid in your recovery.

What is the Cox-Maze Procedure?

During a Cox-Maze procedure, surgeons create a series of safe and effective scars to permanently block the electrical signals triggering the irregular heartbeat. After the procedure, most patients do not need to take blood thinners or other medications.

James Cox, MD, former Washington University doctor, first developed the procedure at Barnes-Jewish Hospital in 1987, using a set of incisions to create the scars. Since Dr. Cox’s innovation, Washington University doctors who work at our hospital have continued to refine the approach.

In 2002, Ralph J. Damiano, Jr., MD, current chief of cardiothoracic surgery at Barnes-Jewish Hospital, developed the use of ablations instead of incisions. Using either hot (radiofrequency) or cold (cryoablation) energy, the ablation version:

  • Provides the same excellent results while more than halving the procedure time
  • Treats the heart more gently
  • Leads to a shorter, easier recovery

Minimally Invasive Cox-Maze Procedure

Surgeons traditionally accessed the heart through an open chest incision (sternotomy) for the Cox-Maze. Our continued commitment to less invasive procedures has led to the mini-thoracotomy approach. We can access your heart from the right side, through your ribs, without a large chest incision.

Some centers that use a minimally invasive approach provide only a partial Cox-Maze procedure. Atrial fibrillation is not always stopped with their method. We provide thorough treatment with our minimally invasive approach, making it more likely the arrhythmia will not come back.

Cox-Maze Procedure: Advantages of Minimally Invasive Approach

Our surgeons have extensive experience in both the minimally invasive and conventional approaches. We will help you determine which approach will give you the best results.

Advantages of the minimally invasive thoracotomy include:

  • Procedure time cut in half
  • Shorter hospitalization
  • Quicker, easier recovery
  • Smaller scar
  • Same excellent results as the sternotomy approach

Cox-Maze Procedure for Atrial Fibrillation: Who is a Candidate?

We may recommend the Cox-Maze procedure if you have atrial fibrillation and

  • Symptoms that have not responded to medical treatment 
  • Return of atrial fibrillation symptoms despite having undergone catheter ablation therapy
  • Upcoming open heart procedure for either coronary artery disease (CAD) or heart valve disease
  • Inability to use long-term anticoagulation (blood thinners, such as Coumadin/warfarin) because of a high risk of bleeding
  • Chronic or persistent atrial fibrillation and a history of stroke despite adequate anticoagulation
  • Tachycardia (rapid heartbeat)-induced cardiomyopathy (heart enlargement), which can lead to heart failure

Cox-Maze Procedure: What to Expect

We perform the Cox-Maze to stop the irregular electrical impulses that cause atrial fibrillation.

During the procedure:

  1. We access your heart, using either a sternotomy or a mini-thoracotomy.
  2. We use hot or cold energy to make ablations on your heart, creating a planned “maze” of scar tissue.
  3. The scar tissue serves as a barrier, guiding irregular cardiac electrical signals back to more normal pathways. This routing restores a regular heartbeat. 
  4. We also close or remove the left atrial appendage (LAA), a common source of blood clots. This step greatly reduces the risk of stroke in atrial fibrillation patients. Learn more about stroke-reducing procedures.

After the procedure:

  1. You typically stay in the hospital for 8 to 10 days.
  2. After 2 days in the intensive care unit, we transfer you to the step-down unit.
  3. You can expect a complete recovery about 4 to 6 weeks after surgery. If we use the minimally invasive approach, your hospital stay and recovery may be shorter.

Contact Us

To make an appointment with a Washington University arrhythmia specialist at Barnes-Jewish Hospital, call 855.925.0631.