Improved combined superior-transseptal approach to the mitral valve

In mitral valve surgery, the combined superior-transseptal approach gives excellent exposure of the mitral valve, but it is lengthy and complex. A modified version of this approach was made without cutting the right atrial appendage and the dome of the right atrium. This shorter procedure was evaluated in 30 patients aged 4-61 years undergoing complex mitral valve operations including mitral repair (33.3%), reoperation (30%), and small left atrium (30%). The mitral valve was exposed well in all cases. Because of the shorter incision, closure was relatively easy. The aortic crossclamp time was 117 +/- 29.9 min (range, 53-173). There were no major complications. Cardiac rhythm resumed spontaneously after release of the aortic clamp in 93.3% of patients, including 36.7% who regained sinus rhythm from arrhythmia preoperatively. There was no heart block, bleeding, or mortality. Results at 3 months were good. Despite a decreased operative field, this modified approach provided adequate exposure for all the required techniques. The benefits of this approach are a shorter incision in the atrial muscle, and simplified closure technique.