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1. Introduction
2. Incision
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a. Perform Median Sternotomy
3. Left Mammary Artery Harvest with Skeletonization Technique
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a. Expose the Chest Wall
b. Identify the Left Internal Mammary Artery
c. Expose the Internal Mammary Artery
d. Heparinize
e. Divide the Conduit
f. Place a Bull-Dog at the End of the Artery
4. Preparation for Bypass and MAZE
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a. Expose and Open Pericardium to Access Heart
b. Suspend the Edges of Pericardium
c. Perform Aortic Ultrasound
d. Synchronize Cardio-Version
e. Place Purse-string Sutures
f. Mobilize Superior Vena Cava
5. Cardiopulmonary Bypass
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a. Cannulate the Aorta
b. Connect the Aortic Cannula to the Bypass Machine
c. Cannulate Superior and Inferior Vena Cava
d. Connect Bicaval Cannulas to Venous Limb of Pump
e. Go On Pump
6. Cox-MAZE IV
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a. Isolate Right Pulmonary Veins, En-Bloc Using Bipolar Radiofrequency Energy
b. Ablate Right Pulmonary Veins Circumferentially
c. Open the Right Atrium
d. Use Bipolar Radiofrequency Clamps to Create Right Atrial Lesion
e. Use Cryoprobe to Create Right Atrial Lesion
f. Close Right Atrium
g. Use Cryoprobe to Create Left Isthmus Lesion
h. Isolate Left Pulmonary Veins
i. Create Left Atrial Lesion
7. Coronary Artery Bypass Grafting
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a. Assess LIMA
b. Identify and Assess the LAD
c. Perform End to Side Anastomosis
8. Mitral Valve Replacement
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a. Perform Left Atriotomy
b. Excise Anterior Leaflet of Mitral Valve
c. Size the Valve
d. Lower Connecting Lesion (MAZE)
e. Create Left Isthmus Lesion (MAZE)
f. Create Roof Lesion (MAZE)
g. Place Interrupted, Everted, Pledgeted Mattress Sutures
h. Give Cardioplegia
i. Implant Valve
j. Tie Down Sutures
k. Close Left Atriotomy
9. Wean from Cardiopulmonary Bypass
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a. Place AV Pacing Wires
b. Start Temporary Pacing
c. Go Off Pump
d. Decannulate
10. Closure
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a. Ensure Hemostasis
b. Place Sternal Wires
c. Close Subcutaneously
d. Close Superficially with Staples
11. Debrief
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Cox-MAZE IV Combined with Coronary Artery Bypass Graft and Mitral Valve Replacement
Andrew Del Re
1
;
Marco Zenati, MD
2
1
The Warren Alpert Medical School of Brown University
2
Brigham & Women’s Hospital, VA Boston Healthcare System
Tags:
Cardiac Surgery
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Authors
Marco Zenati, MD
Andrew Del Re
Filmed At:
VA Boston Healthcare System
Article Information
Publication Date
N/A
Article ID
175
Production ID
0175
Volume
N/A
Issue
175
DOI
https://doi.org/10.24296/jomi/175