Extended Vertical Transseptal Approach versus Transseptal Approach for Mitral Valve Operation
Background: Adequate exposure of the mitral valve is a critical factor of success for either replacement or repair of the mitral valve. In the present study, we evaluated the merits of the extended vertical transseptal approach in comparison with the transseptal approach for mitral valve operations.
Methods: A total of 72 consecutive patients operated on for mitral procedures were allocated to either group A (those operated on through an extended vertical transseptal approach [n = 38]) or group B (whose mitral valve exposure was achieved through a right atrium transseptal approach [n = 34]). The operation time, aortic cross-clamp time, first 24-hour drainage volume after the operation, and the rhythms pre- and postsurgery were compared between the 2 groups.
Results: The mean operation time and mean cross-clamp time in group A were longer than that in group B and the drainage volume was greater in the first 24 hours, but the differences were not statistically significant. There was no surgical reexploration for bleeding in either group. For the 13 patients who had normal sinus rhythm preoperatively in group A, 2 (15.4%) developed episodes of atrial fibrillation and 1 (7.7%) developed temporary sinus bradycardia requiring temporary pacing in the immediate and early postoperative period. In group B, 2(15.4%) of patients with normal sinus rhythm before surgery developed atrial fibrillation that continued until 1 week after surgery.
Conclusion: The extended vertical transseptal approach not only affords excellent exposure of the mitral valve, but also is safe for maintaining sinus node function compared with the transseptal approach.
Aykut K, Celik B, Ac?kel U. 2011. The transseptal approach to the mitral valve during multivalvular surgery. J Card Surg 26:472-4.nBalasundaram SG, Duran C. 1990. Surgical approaches to the mitral valve. J Card Surg 5:163-9.nBrawley RK. 1980. Improved exposure of the mitral valve in patients with a small left atrium. Ann Thorac Surg 29:179-81.nBusquet J, Fontan F, Anderson RH, Ho SY, Davies MJ. 1984. The surgical significance of the atrial branches of the coronary arteries. Int J Cardiol 6:223-36.nCaetano AG, Lopes AC, DiDio LJ, Prates JC. 1995. Critical analysis of the clinical and surgical importance of the variations in the origin of the sinoatrial node artery of the human heart. [in Portuguese] Rev Assoc Med Bras 41:94-102.nDubost C, Guilmet D, Parades B, Pedeferri G. 1966. New technic of opening of the left auricle in open-heart surgery: the transsseptal bi-auricular approach. [in French] Presse Med 74:1607-8.nGarcía-Villarreal OA, González-Oviedo R, Rodríguez-González H, Martínez-Chapa HD. 2003. Superior septal approach for mitral valve surgery: a word of caution. Eur J Cardiothorac Surg 24:862-7.nGuiraudon GM, Ofiesh JG, Kaushik R. 1991. Extended vertical transatrial septal approach to the mitral valve. Ann Thorac Surg 52:1058-60.nKumar N, Saad E, Prabhakar G, De Vol E, Duran CM. 1995. Extended transseptal versus conventional left atriotomy: early postoperative study. Ann Thorac Surg 60:426-30.nKunitomo R, Okamoto K, Utoh J, et al. 2001. Evaluation of superior transseptal approach for the removal of left atrial myxoma. [in Japanese] Kyobu Geka 54:211-4.nKyriakidis M, Vyssoulis G, Barbesetas J, Toutouzas P. 1988. A clinical angiographic study of the arterial blood supply to the sinus node. Chest 94:1054-7.nLukac P, Hjortdal VE, Pedersen AK, Mortensen PT, Jensen HK, Hansen PS. 2007. Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach. Ann Thorac Surg 83:77-82.nMisawa Y, Fuse K, Kawahito K, Saito T, Konishi H. 1999. Conduction disturbances after superior septal approach for mitral valve repair. Ann Thorac Surg 68:1262-4.nNienaber JJ, Glower DD. 2006. Minitransseptal versus left atrial approach to the mitral valve: a comparison of outcomes. Ann Thorac Surg 82:834-9.nOkmen AS, Okmen E. 2009. Sinoatrial node artery arising from posterolateral branch of right coronary artery: definition by screening consecutive 1500 coronary angiographies. Anadolu Kardiyol Derg 9:481-5.nOzturk E, Saglam M, Bozlar U, et.al. 2011. Arterial supply of the sinoatrial node: a CT coronary angiographic study. Int J Cardiovasc Imaging 27:619-27.nSalerno TA, Suarez M, Panos AL, et al. 2009. Results of beating heart mitral valve surgery via the transseptal approach. Rev Bras Cir Cardiovasc 24:4-10.nSantibáñez Escobar F, Serrano Gallardo G, Ramirez Marroquin S, Lopez Soriano F, Barragán García R. 1997. The transseptal approach for mitral valve replacement revisited. Tex Heart Inst J 24:209-14.nTakeshita M, Furuse A, Kotsuka Y, Kubota H. 1997. Sinus node function after mitral valve surgery via the transseptal superior approach. Eur J Cardiothorac Surg 12:341-4.nTenpaku H, Wariishi S, Kanemitsu N, Okabe M, Nakamura T. 2000. Combined superior-transseptal approach versus conventional approach for mitral valve surgery. Jpn J Thorac Cardiovasc Surg 48:688-92.n
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