Hybrid Cardiac Ablation & Minimally Invasive Cox Maze Procedure

If you have atrial fibrillation, also called AF, your doctor may discuss several treatment options with you. These options may include surgery. Advanced surgical options include hybrid surgical-catheter ablation and minimally invasive Cox Maze procedure.

What is atrial fibrillation (AF)?

  • In atrial fibrillation, also called AF, abnormal electrical signals cause the upper chambers of the heart to quiver instead of beating normally. AF is serious and requires treatment.
  • increases the risk of stroke significantly, requiring patients to take blood thinners for the long term.
  • can cause heart failure because it interferes with the heart’s efficiency as a pump, forcing it to work harder. The heart can become enlarged as a result.
  • is, like high blood pressure, a general health risk.

AF patients who don’t respond well to medication often require cardiac ablation, a class of procedures that strategically creates lines of scar tissue to block transmission of the abnormal electrical signals that underlie atrial fibrillation. Cardiologists generally direct their AF patients to catheter-based ablations. However, patients with non-paroxysmal (persistent) or chronic AF often require multiple procedures, and the abnormal rhythm frequently comes back.

At Stanford, we offer atrial fibrillation patients comprehensive options focused on minimally invasive approaches that provide more durable results than catheter ablation alone.

Recommended Treatments for Atrial Fibrillation Not Responding to Medication

Patients whose AF is persistent or long-standing may therefore require surgical ablation. The Cox Maze procedure has long been considered the "gold standard" treatment, but it is an open-heart surgery that calls for cardiopulmonary bypass.

For patients who already require open-heart surgery, we can perform a Cox Maze procedure at the same time. Patients who aren’t already planning open-heart surgery can opt for either a Cox Maze or a hybrid ablation.
At Stanford, we often perform the Cox Maze procedure with a minimally invasive, 5-centimeter anterior thoracotomy incision.

Hybrid ablation offers an even less invasive alternative for eligible patients. Hybrid ablation combines catheter ablation with a minimally invasive surgical ablation for the best care short of Cox Maze surgery. We perform surgical ablation on the outside of the heart through a video-assisted thoracoscopic (VATS) technique. There’s no need to spread the patient’s ribs with this technique, reducing pain and speeding healing. We combine this with a catheter ablation, which targets the inside of the heart. Early results suggest this combination is nearly as effective as the open heart Cox Maze procedure.

For patients who require or prefer the Cox Maze procedure, Stanford is a leading provider. We can often use a minimally invasive approach, with a 5-centimeter incision rather than a median sternotomy.

Hybrid Ablation

Hybrid ablation combines minimally invasive surgical ablation for the outer (epicardial) surface of the heart, with catheter ablation of the inner (endocardial) part of the heart.

Benefits of hybrid ablation

  • A cardiac surgeon performs the surgical ablation through a Video-Assisted Thoracoscopic Surgery (VATS) incision pattern, which consists of three 1-cm incisions on each side of the chest.
  • The smaller incisions reduce the risk of infection and the time required to recover from surgery.
  • Patients do not undergo cardiopulmonary bypass, which substantially reduces the risk of the surgery.
  • The endocardial ablation, which is performed by an electrophysiologist (or EP), is done separately to minimize patients’ time in the operating room. The procedure can be done in the same hospital stay with the VATS surgical ablation or the two procedures can be spaced out over a few weeks or months if necessary.
  • Early results show the hybrid procedure to be as effective as Cox Maze.

Minimally Invasive Cox Maze Procedure

Patients with non-paroxysmal (or persistent) atrial fibrillation which has lasted for several years and/or whose left atrium is significantly enlarged are best treated with Cox Maze surgery. Patients whose symptomatic AF returns after other procedures are also referred for Cox Maze surgery.

At Stanford, we treat many patients with a minimally invasive Cox Maze procedure that shortens recovery time and reduces the risk of infection.

Benefits of the Minimally Invasive Cox Maze Procedure

  • Minimally invasive Cox Maze procedures are done through a 5-cm thoracotomy incision. This approach reduces the risk of complications.
  • Average hospital stay with the minimally invasive procedure is just 5-7 days, versus 9 days with median sternotomy. Recovery time is also faster.
  • Patients who aren’t eligible for the minimally invasive procedure can count on Stanford’s experience with the traditional "open" Cox Maze. We have specialized expertise in this successful procedure as well.

Whether hybrid cardiac ablation, minimally invasive Cox Maze or traditional Cox Maze surgery is right for you, Stanford provides important advantages.

Stanford Health Care has been identified by U.S. News & World Report as one of the top hospitals in the country, year after year. Our cardiac care doctors have adopted newer teamwork approaches. Ablation experts regularly collaborate with other cardiac surgeons to perform surgical ablations when patients are already undergoing more invasive procedures. Our arrhythmia surgeons work closely with our electrophysiologists to provide the best, personalized care for every patient.

"Patients can get conflicting information on whether they should have a catheter ablation or Cox Maze surgery. Because the Stanford electrophysiology section and I work so closely together, we can help patients find treatment options that balance aggressively treating the disease and conservatively minimizing the patient’s risk."

— Anson Lee, MD

Transfer Center and Referral Information

Patients and Families (Self-Referral)

The patient’s doctor will request an evaluation by the Stanford Advanced Lung Support team, who will review their previous medical records and determine if additional tests are necessary. After reviewing the patient’s information, the team will provide further details regarding patient transfer.   You can call the clinic number below to speak with one of our clinic staff about the status of your referral or self-referral.  They will help guide you through the process or next steps needed.  

We use a multi-disciplinary approach to diagnose and treat patients with valvular heart disease, offering repair and replacement for heart valves.

Stanford Referral Center and Clinics are staffed Monday through Friday from 8 am - 5 pm (PST)

We have several locations where our surgeons can see you for a consult, offering you convivence closest to your home.    

Our main Adult Heart Surgery Clinic & Surgery schedulers number to call for an appointment is: 650-724-7500

Our direct clinic contact information and locations are:

Heart Surgery in Palo Alto
Heart and Vascular Center
300 Pasteur Drive
3rd Floor, Clinic A31
Stanford, CA 94305
Phone: 650-724-7500
Map of Stanford Hospital

Aortic Disease Center
Heart and Vascular Center
300 Pasteur Drive
3rd Floor, Clinic A31
Stanford, CA 94305
Map of Stanford Hospital

Heart Surgery in Pleasanton 
5565 W. Las Positas Blvd.
Suite 320
Pleasanton, CA 94588
Phone: 925-278-7017

Heart Surgery in San Jose
751 S. Bascom Avenue
San Jose, CA 95128
Phone: 408-885-3838

Interested in an Online Second Opinion?

The Stanford Medicine Online Second Opinion program offers you easy access to our world-class doctors. It’s all done remotely and you don’t have to visit our hospital or one of our clinics for this service. You don’t even need to leave home! Visit our online second opinion page to learn more.

International Patient Referrals

Phone: +1 650-723-8561
Email: IMS@stanfordhealthcare.org

International Medical Services (IMS) at Stanford Health Care provides information, interpretation and translation services, and other supportive services for patients and families who may be seeking care from out of country.  

For Physicians / Health Care Professionals

Transfer Center
Phone: 1-800-800-1551  (24 hours - 7 days a week)
Fax: 650-723-6505

Physician Helpline
Phone: 1-866-742-4811 
Fax: 650-320-9443
Monday – Friday  8:30 a.m. – 5 p.m. (PST)
After hours: Call the hospital page operator at 650-723-4000 and ask for the physician on call

FAX: Fax a referral to the Cardiothoracic Surgery Department at 650-736-0901  

Online Portal (PRISM)

Our online portal, known as PRISM (Physician Referral Information at Stanford Medicine), provides a streamlined platform for community physicians to send referrals, check on referral status, access medical records, and message Stanford providers.

If you have any questions about the referral process, please call us at 650-724-7500.