Totally Extracardiac Maze Procedure Performed on the Beating Heart

The cut-and-sew Cox Maze III procedure is a complex operation. A novel vacuum-integrated radiofrequency ablation device was developed to attenuate the complexity. This device has enabled the development of a totally extracardiac Maze (Ex-Maze) procedure. We describe the Ex-Maze procedure, which closely mimics the gold standard Maze III pattern and includes lines of ablation that isolate the pulmonary veins, interconnect the left and right atria, and a line that extends from the right inferior pulmonary vein to the medial inferior vena cava.