Welcome to the first episode of “All Things AFib.” I am your host, Dr. Armin Kiankhooy. As a board-certified cardiothoracic surgeon, my focus is on advanced treatments for heart and lung failure and minimally-invasive surgical treatments for atrial fibrillation such as the Hybrid Maze procedure. You can find me on staff at Adventist Health Heart and Vascular Institute in St. Helena California. 

For our inaugural episode, I’m thrilled to welcome Dr. James Cox, a legend in the field of cardiothoracic surgery, and inventor of the Cox maze surgery. The world is lucky that Dr. Cox decided to become a surgeon because he also had an offer to play professional baseball with the LA Dodgers. 

Dr. Cox was the Evarts A. Graham Professor of Surgery, vice-chairman of the department of surgery, and chief of the division of cardiothoracic surgery at Washington University School of Medicine and Barnes Hospital in St. Louis, MO. It was here in 1987 that he developed the eponymous “maze” procedure, which is still the gold standard in the world today. 

Dr. Cox was the 81st (and youngest) president of the American Association for Thoracic Surgery (AATS), a member of the editorial board of more than 20 scientific journals, and editor-in-chief of two AATS journals. Among the numerous awards and honors he has received throughout his illustrious career, Dr. Cox is the only surgeon to receive the Distinguished Scientist Award from the AATS, the Society of Thoracic Surgeons, and the Heart Rhythm Society. He is the only U.S. cardiac surgeon in the Russian Academy of Medical Sciences. 

Cox is dedicated to clinical excellence, the development of new techniques, and the training of the next generation of surgeons. 

Discussion points:

What is Atrial Fibrillation (AFib)?

The AFib word origins actually meant the appearance of a “sack of worms”

The two types of Macro Re-Entry– Automaticity and micro/macro re-entry

Treatment methods– Cardiothoracic Surgeons vs. Electrophysiologists

The technicalities of terms Maze III vs. Maze IV, the confusion, and even a lawsuit

What are the confusing statistics around pacemaker implantation and the Cox maze procedure?

Post-operative and medicinal damage to the sinus node

Around 5% of patients may need pacemakers due to “sick” sinus nodes, not AFib surgery

A discussion of Left Atrial Appendage management

Is there a percentage of AFib patients that should have more than the Left Atrial closure procedure?

Do we need to get more surgeons to do Left Atrial closure?

Discussion of hybrid maze procedures

Will we still be doing maze procedures in 30 years?

Imagining tools we may be using in the future

Resources:

Dr. James Cox Original Papers: 

The surgical treatment of atrial fibrillation. I. Summary of the current concepts of the mechanisms of atrial flutter and atrial fibrillation. 

The surgical treatment of atrial fibrillation. II. Intraoperative electrophysiologic mapping and description of the electrophysiologic basis of atrial flutter and atrial fibrillation. 

The surgical treatment of atrial fibrillation. III. Development of a definitive surgical procedure. 

Modification of the maze procedure for atrial flutter and atrial fibrillation. I. Rationale and surgical results. 

Modification of the maze procedure for atrial flutter and atrial fibrillation. II. Surgical technique of the maze III procedure.

Dr. James Cox LinkedIn

Dr. James Cox Receives Jacobson Innovation Award 

Dr. Kiankhooy LinkedIn

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