Development of the Maze procedure and the contribution of Japanese surgeons.

OBJECTIVE: The Cox-Maze procedure is the most popular surgical procedure in the world for eliminating atrial fibrillation (AF). Japanese surgeons performed and modified its procedure. This review describes the concept of the Maze procedure, modifications of the Maze procedure and findings related to the Maze procedure obtained by Japanese surgeons.

METHODS: Original Cox-Maze procedures and modified Maze procedures developed by Japanese surgeons were reviewed chronologically.

RESULTS: Japanese surgeons modified Cox-Maze II and III procedures, including Kosakai-Maze procedure, Cryo-Maze procedure, the Radial approach and the left atrial Maze procedure, and there were many midterm and long-term clinical results of the original and modified Maze procedures especially for AF associated with mitral valve disease. These modifications may be possible to elucidate the mechanism of paroxysmal AF. The mechanism of persistent AF is presumed to be multiple reentry based on the success of surgical approaches as well as electrophysiological study.

CONCLUSION: Japanese surgeons have modified and simplified the Maze procedure, and have improved the Maze procedure as well as helped to clarify the mechanisms of AF.