Cox Minimaze


Surgical cure of AF was pioneered by James Cox, MD, in the 1980s and 1990s. He and his colleagues developed the "Maze" or "Cox-Maze" procedure and performed the first one in 1987, publishing his results in 1991 (Cox 1991). Success was good, but the surgery was complex, complications occurred, and this procedure wasn't widely adopted. Nevertheless, it formed the basis for advanced minimally invasive surgery available today, and the Cox-Maze III continues to be considered the “gold standard” for such procedures (Calkins 2007).

Great efforts were made by many to reduce the complexity of the Cox-Maze procedure, primarily by reducing the number of incisions on the heart; these procedures were generally referred to as “minimaze” or “mini-maze” procedures. The exact incisions required to cure AF were (and are) still being clarified. Dr. Cox concluded that some critical lesions could only be performed by stopping the heart and using cardiopulmonary bypass, and in 2004 (Cox 2004) he defined the Cox Mini-Maze:

“In summary, it would appear that placing the following lesions can cure most patients with atrial fibrillation of either type: pulmonary vein encircling incision, left atrial isthmus lesion with its attendant coronary sinus lesion, and the right atrial isthmus lesion. We call this pattern of atrial lesions the “Mini-Maze Procedure”.


Interestingly, this definition excluded some of the newer forms of minimaze procedures that were about to be developed.