Comparison of superior septal approach with left atriotomy in mitral valve surgery

• Published in: Revista brasileira de cirurgia cardiovascular Vol. 29; no. 3; pp. 367 - 373
• Main Authors: Aydin, Ebuzer, Arslan, Akin, Ozkokeli, Mehmet
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Cirurgia Cardiovascular 01-07-2014
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; CARDIAC & CARDIOVASCULAR SYSTEMS; Cardiology; Complicações Pós-Operatórias; Doenças das Valvas Cardíacas; Electrocardiography; Eletrocardiografia; Female; Fibrilação Atrial; Heart Atria - physiopathology; Heart Atria - surgery; Heart Septum - physiopathology; Heart Septum - surgery; Heart surgery; Heart Valve Diseases - physiopathology; Heart Valve Diseases - surgery; Humans; Length of Stay; Male; Middle Aged; Mitral Valve - physiopathology; Mitral Valve - surgery; Postoperative Period; Septo Interatrial; Statistics, Nonparametric; Stroke Volume - physiology; SURGERY; Treatment Outcome; Young Adult; Átrios do Coração; Heart Valve Diseases; Doenças das Valvas Cardíacas; Heart Atria; Atrial fibrillation; Electrocardiography; Átrios do Coração; Eletrocardiografia; Complicações Pós-Operatórias; Atrial Septum; Fibrilação Atrial; Postoperative Complications; Septo Interatrial
• ISSN: 0102-7638; 1678-9741; 1678-9741
• DOI: 10.5935/1678-9741.20140045

In this study, we aimed to compare clinical outcomes of superior transseptal approach with the conventional left atriotomy in patients undergoing mitral valve surgery.
Between January 2010 and November 2012, a total of 91 consecutive adult patients (39 males, 52 females; mean age: 54.0±15.4 years; range, 16 to 82 years) who underwent mitral valve surgery in the Division of Cardiovascular Surgery at Koşuyolu Training Hospital were included. The patients were randomized to either superior transseptal approach (n=47) or conventional left atriotomy (n=44). Demographic characteristics of the patients, comorbidities, additional interventions, intraoperational data, pre- and postoperative electrophysiological study findings, and postoperative complications were recorded.
Of all patients, 86.7% (n=79) were in New York Heart Association Class III, while 12 were in New York Heart Association Class IV. All patients underwent annuloplasty (42.9%) or valve replacement surgery (57.1%). There was no significant difference in pre- and postoperative electrocardiogram findings between the groups. Change from baseline in the cardiac rhythm was statistically significant in superior transseptal approach group alone (P<0.001). There was no statistically significant difference in mortality rate between the groups. Permanent pacemaker implantation was performed in 10.6% of the patients in superior transseptal approach group and 4.5% in the conventional left atriotomy group. No statistically significant difference in bleeding, total length of hospital and intensive care unit stay, the presence of low cardiac output syndrome was observed between the groups.
Our study results suggest that superior transseptal approach does not lead to serious or fatal adverse effects on sinus node function or atrial vulnerability, compared to conventional approach.