Cox Maze III Procedure and Complex Mitral Valve Repair of a Calcified Annulus 

In this video, Dr Vince Gaudiani demonstrates a Cox maze III procedure and how to perform a complex repair of a calcified posterior leaflet. He began by performing a full sternotomy and aortic and venous cannulation.  He then administered antegrade cardioplegia and placed a right superior pulmonary vein vent.   

The Cox maze III procedure was started with a vertical incision down the right atrium. A Bovie was then used to make an incision from the medial tricuspid trigone to the inferior vena cava (IVC) and an incision from the lateral trigone to the base of the atrial appendage.  The Sondergaard’s groove was opened and a cut was made around most of the pulmonary veins. An epicardial and endocardial cryoablation line was made over the left pulmonary veins that were not cut.  An endocardial and epicardial cryo line was made from the mitral annulus to the incision and the coronary sinus was intentionally frozen.   

The left atrial appendage was stapled off. The left atrium was very large so a portion was cut away to reduce its size.  

The mitral valve repair was then performed.  There was a large bank of calcium between A1 and P1 and the leaflet was detached, so the area was then decalcified.  The leaflets were then sutured back onto the annulus and the commissure was reconstructed.  A deep cleft between P2 and P3 was also closed.   

The 16 mm Onyx Chord-X premade chord system was used to place three sets of chords from the posteromedial papillary muscle to the posterior leaflets. An annuloplasty ring was then placed, and the valve was tested and found to be an excellent repair. The left and right atria were then closed.   

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