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  • Title
  • 1. Introduction
  • 2. Incision
  • 3. Left Mammary Artery Harvest with Skeletonization Technique
  • 4. Preparation for Bypass and MAZE
  • 5. Cardiopulmonary Bypass
  • 6. Cox-MAZE IV
  • 7. Coronary Artery Bypass Grafting
  • 8. Mitral Valve Replacement
  • 9. Wean from Cardiopulmonary Bypass
  • 10. Closure
  • 11. Post-op Remarks

Cox-MAZE IV with Coronary Artery Bypass Graft (CABG) and Mitral Valve Replacement (MVR)

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Andrew Del Re1; Marco Zenati, MD2
1 The Warren Alpert Medical School of Brown University
2 Brigham & Women’s Hospital, VA Boston Healthcare System

Cardiac Surgery

Procedure Outline

Table of Contents

  1. 1. Introduction
    1. 2. Incision
      1. 3. Left Mammary Artery Harvest with Skeletonization Technique
        1. 4. Preparation for Bypass and MAZE
          1. 5. Cardiopulmonary Bypass
            1. 6. Cox-MAZE IV
              1. 7. Coronary Artery Bypass Grafting
                1. 8. Mitral Valve Replacement
                  1. 9. Wean from Cardiopulmonary Bypass
                    1. 10. Closure
                      1. 11. Post-op Remarks
                        1. Perform Median Sternotomy
                        1. Expose the Chest Wall
                        2. Identify the Left Internal Mammary Artery
                        3. Expose the Internal Mammary Artery
                        4. Heparinize
                        5. Divide the Conduit
                        6. Place a Bull-Dog at the End of the Artery
                        1. Expose and Open Pericardium to Access the Heart
                        2. Suspend the Edges of Pericardium
                        3. Perform Aortic Ultrasound
                        4. Synchronize Cardio-Version
                        5. Place Purse-String Sutures
                        6. Mobilize Superior Vena Cava
                        1. Cannulate the Aorta
                        2. Connect the Aortic Cannula to the Bypass Machine
                        3. Cannulate Superior and Inferior Vena Cavae
                        4. Connect Bicaval Cannulas to Venous Limb of Pump
                        5. Go on Pump
                        1. Isolate Right Pulmonary Veins En-Bloc Using Bipolar Radiofrequency Energy
                        2. Ablate Right Pulmonary Veins Circumferentially
                        3. Open the Right Atrium
                        4. Use Bipolar Radiofrequency Clamps to Create Right Atrial Lesion
                        5. Use Cryoprobe to Create Right Atrial Lesion
                        6. Close Right Atrium
                        7. Use Cryoprobe to Create Left Isthmus Lesion
                        8. Isolate Left Pulmonary Veins
                        9. Create Left Atrial Lesion
                        1. Assess LIMA
                        2. Identify and Assess the LAD
                        3. Perform End-to-Side Anastomosis
                        1. Perform Left Atriotomy
                        2. Excise Anterior Leaflet of Mitral Valve
                        3. Size the Valve
                        4. Lower Connecting Lesions (MAZE)
                        5. Create Left Isthmus Lesion (MAZE)
                        6. Create Roof Lesion (MAZE)
                        7. Place Interrupted, Everted, Pledgeted Mattress Sutures
                        8. Give Cardioplegia
                        9. Implant Valve
                        10. Tie Down Sutures
                        11. Close Left Atriotomy
                        1. Place AV Pacing Wires
                        2. Start Temporary Pacing
                        3. Go Off Pump
                        4. Decannulate
                        1. Ensure Hemostasis
                        2. Place Sternal Wires
                        3. Close Subcutaneously
                        4. Close Superficially with Staples

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                        Authors

                        Filmed At:

                        VA Boston Healthcare System

                        Article Information

                        Publication Date
                        Article ID175
                        Production ID0175
                        Volume2024
                        Issue175
                        DOI
                        https://doi.org/10.24296/jomi/175