Extended vertical transseptal approach versus conventional left atriotomy for mitral valve surgery

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery

Background:

• Optimal exposure is crucial for mitral valve surgery, especially for conservative procedures.
• The vertical transseptal approach is a routinely adopted technique in some institutes.

Purpose of the Study:

• To compare surgical outcomes of mitral valve surgery using the vertical transseptal approach versus conventional left atriotomy.
• To evaluate the efficacy and safety of the transseptal approach for mitral valve repair and replacement.

Main Methods:

• A retrospective study of 172 consecutive patients undergoing mitral valve procedures.
• Group A (n=62) underwent conventional left atriotomy; Group B (n=110) used the vertical transseptal approach.

Main Results:

• Group B showed significantly increased ischemia time (48.1 vs 37.4 min) and postoperative bleeding (400 vs 277 ml) compared to Group A (p=0.004).
• Group B had a higher incidence of postoperative junctional arrhythmia in patients with preoperative sinus rhythm (p<0.001).
• Both groups had similar mortality rates (2% in Group A, 2.7% in Group B) and no technique-related re-explorations for bleeding.

Conclusions:

• The transseptal atriotomy provides superior exposure for mitral valve surgery, facilitating more complete reconstruction.
• Despite minor increases in ischemia time and bleeding, the benefits of improved surgical exposure are significant.
• The increased incidence of temporary junctional arrhythmia necessitates vigilant postoperative monitoring.