Evolution of the maze III procedure: are modifications necessary?

The maze III procedure has been the culmination of multiple surgical approaches for supraventricular arrhythmias. Its success in curing atrial fibrillation has generated multiple modifications which constitute attempts to simplify the operation, particularly with associated mitral or multiple valvular pathology. Our preference in these patients, however, has been to employ the original maze III procedure without modification. This review tracks the development of the maze III procedure and its modifications and compares the early outcomes in patients requiring the maze procedure combined with mitral and additional valvular procedures.