Posted by Jack Drum on April 26, 2002 at 21:35:57:
Here is a letter I received today from Dr. James L. Cox. No introduction needed.
This in the theme of what I posted about the Atrial Fibrillation Foundation web site, on 1-31-02. The Foundation's page on the Maze procedure is full of outdated and misinformation about the Maze. I brought their errors to their attention, but to no avail.
Dr. Cox, backs up what I had mailed them, but with authority of his own experience, and in a much more comprehensive manner.
The following is a portion of the letter to me, and his entire letter to the Atrial Fibrillation Foundation.Dear Jack,
It is fine with me for you to post my note on the website. I do keep up with most of the Maze/ A-fib sites but not as much as I once did.
Your web page is an excellent contribution to the well-being of a lot of patients.In view of your recent postings regarding your dismay with the Maze information on the Atrial Fibrillation Website, I thought you might like to see what I wrote to them today. Hope you are continuing to do well.
James L. Cox, M.D.
Dear Sir/Madam:
I am sorry that I do not know to whom this letter is being written since I do not know the author of the material on your website. As the creator of the "Maze" procedure, however, I feel compelled to correct some of the misconceptions that you apparently have regarding the procedure. Your descripton of this surgical procedure on your website is so uninformed and outdated that your apparent attempt to present options to patients in a fair and objective manner borders on the comical.
You first state that unless patients need cardiac surgery for other reasons, the Maze is performed "infrequently". That is true enough, but it is applied infrequently only because of the ignorance regarding the Maze procedure that exists in the non-surgical medical community, a fact substantiated by your article.
First, you describe the old cut-and-sew technique for the Maze procedure which we have not employed, except under unusual circumstances, since 1998. You then state that this cut-and-sew technique is used by surgeons today when performing a variant of the Maze procedure in combination with mitral valve surgery...to my knowledge, not a single surgeon in the world still does that procedure!
You then go on to say that when this cut-and-sew technique was used in the past to treat AF in combination with mitral valve surgery, it "...involves considerable risk". Where did you get that information? We have documented on numerous occasions that there is absolutely no additional risk in performing the old cut-and-sew Maze procedure in combination with mitral valve surgery and that, in fact, the short and long term results of combining the two are quite superior to leaving the patient in AF following valve surgery. This has been confirmed by the Mayo Clinic group as well as by several foreign groups.
As indicated above, the cut-and-sew technique, safe and effective as it was, has been obsolete for at least 4 years when we began to use cryosurgery almost exclusively. In addition, beginning in 1996, we performed the Maze procedure, either alone or in combination with mitral valve surgery, via two different minimally-invasive approachs as our procedures of choice. Newer ablative energy sources, such as radiofrequency (used in thousands of surgical patients thus far) and microwave energy (used in well over 1000 open-heart cases thus far) are being used clinically on a routine basis. In fact, in the year 2002, many leading surgeons consider it to be malpractice if AF associated with mitral valve disease is not treated at the time of the mitral valve surgery.
In the last sentence of your first paragraph, you note that "some PATIENTS..." choose to have the Maze procedure for lone AF. Is this meant to imply (as it most certainly does) that the PHYSICIANS treating those patients do not participate in this choice to have the Maze? You might be interested to know that at the time of my health-forced retirement from clinical practice two years ago, I was performing, on the average, one Maze procedure PER DAY and that virtually all of those patients had been referred to me by their family physicians, internists, cardiologist, or electrophysiologist.
Next, you mention "stroke" as a major complication of the Maze procedure. For your information the incidence of peri-operative stroke (major and minor) for all Maze patients from patient # 1 on September 25, 1987 to the last one I did in May, 2000, was 0.7%. I would submit that this compares "rather favorably" with the incidence of perioperative stroke associated with CABG which the STS National Adult Cardiac Surgery Database reports as 2.3%, especially in view of the fact that 25% of the Maze patients had already had a stroke before surgery! This stroke rate for the Maze procedure is also less than the stroke rate associated with catheter attempts at treating AF, even though the latter patients had no history of previous stroke! Somehow, I missed that point on your website.
You then go on to say that there is an additive risk of the Maze procedure when performed in association with other cardiac surgery, a statement that is absolutely untrue. I believe that it is encumbent upon you to learn the facts before sending this type of erroneous information out to unsuspecting patients.
By the way, the person who called my attention to this website and its erroneous and/or outdated information is someone on whom I performed a Maze procedure (even the old cut-and-sew technique) several years ago for lone atrial fibrillation. He was so appalled by the misinformation and misleading content in your piece on the Maze procedure that he posted his dismay on another website that is devoted to Post-Maze procedure patients (middietofutah.com WWW Board). Perhaps you might wish to direct your patients there or to an even more instructive website that has now been up for over 3 years. You can reach it by going to Yahoo and typing in the phrase "atrial fibrillation". Judging from the quality of your article on the Maze procedure, it would probably be worthwhile for you to log on sometime.
James L. Cox, M.D.
- Excellent John Behle 23:31:31 4/26/2002 (2)
- Re: Excellent Jack Drum 23:46:41 4/26/2002 (1)
- I just tracked them down - it is a little negative John Behle 23:59:36 4/26/2002 (0)