Left Atrial Roof Incision for Mitral Valve Interventions and Left Atrial Mass Resection: A Safe Alternative for Excellent Exposure. A Single Center Experience
Keywords:Left atrial roof, left atrial dome, superior incision, superior approach, mitral valve
Background: Proper visualization has always been the cornerstone for conducting proper cardiac interventions. Although many incisions have been described for mitral valve exposure, the feasibility of some comes at the expense of proper exposure. When it comes to a small left atrium, larger incisions may venture into critically situated structures, creating a heavy toll of increased morbidity and mortality. We aim to evaluate the safety and efficacy of a superior left atrium approach for mitral valve interventions and left atrial mass resection, particularly in a small left atrium.
Methods: We present our experience and early results as a retrospective study conducted at Cardiothoracic Surgery Department, Ain-Shams University, Cairo, Egypt. A total of 85 patients underwent mitral valve interventions and left atrial mass resection through limited incision in the left atrial dome.
Results: The study included 29 female patients and 56 male patients with a mean age of 42.56 ± 7.39 years. Twenty-seven patients were NYHA class I-II and 58 patients were class III-IV. Mean ejection fraction was 55.47 ± 8.56. Three patients had mitral valve repair, 67 patients had mitral valve replacement, and 15 patients had resection of left atrial myxomas. Preoperative atrial fibrillation was present in 27% of the patients. Two patients had new incidence of atrial fibrillation, one patient had new atrial flutter, and one patient had complete heart block, requiring a permanent pacemaker. No mortality occurred in the series, and three patients needed re-exploration for bleeding.
Conclusions: Limited left atrial roof incision provides a safe and feasible exposure for conducting mitral valve interventions and resection of left atrial masses, especially in cases with a small left atrium.
El-Hassan NB, Faragalla AA, Elfadil S, et al. 2017. Primary pulmonary vein leiomyosarcoma presenting as left atrial mass: A case report. JESCTS 25:109-13.
Hirt S, Frimpongboateng K, Borst H. 1988. The superior approach to the mitral valve — is it worthwhile? Eur J Cardiothorac Surg 2:364-71.
Larbalestier RI, Chard RB, Cohn LH. 1992. Optimal approach to the mitral valve: Dissection of the interatrial groove. Ann Thorac Surg 54:1186-8.
Légaré JF, Buth KJ, Arora RC, et al. 2003. The dome of the left atrium: an alternative approach for mitral valve repair. Eur J Cardiothorac Surg 23:272–6.
Meyer BW, Verska JJ, Lindesmith GG, et al. 1965. Open repair of mitral valve lesions: the superior approach. Ann Thorac Surg 1:453-7.
Molina JE. 1988. The superior approach for mitral valve replacement. J Thorac Cardiovasc Surg 3:203-13.
Pezzella AT, Utley JR, Salm TJ. 1998. Operative approaches to the left atrium and mitral valve: an update. Oper Tech Thorac Cardiovasc Surg 3:74-94.
Saksena DS, Tucker BL, Lindersmith GG, et al. 1971. The superior approach to the mitral valve. Ann Thorac Surg 12:146.
Spadaccio C, Elkasrawy K, Sutherland FWH. 2017. New minimally invasive surgical approach for excision of left atrial myxoma. Gen Thorac Cardiovasc Surg 65:605-8.
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