Optimal approach for mitral valve surgery

It seems that mitral valve (MV) replacement technique is already standardized but still under discussion is the surgical approach. At Heart Surgery Clinic of Vilnius University MV replacement was started in 1970 (our total experience in valve surgery is 4396 operations). The most popular surgical approach was through left atrium (LA) from the right side. In cases with small atrium we used right atrial and transseptal and transverse transeptal biatrial (TTBA) approach. Left atrium approach is quite useful in many cases except those with small LA, LV hypertrophy and heart rotation when it can result a greater trauma for the heart, extended time of operation and, possibly, reduced performance after it. From September 1992 till May 1993 we used extended vertical transseptal (EVT) approach in 18 patients for MV replacement or repair, mitral and aortic valve replacement was performed for 5 patients, mitral valve replacement and tricuspid valvuloplasty for 13 patients, 5 patients had mitral valve reoperations and for 3 patients aortocoronary by-pass performed additionally. The technique used was exactly as proposed by O. Alfieri et al, and incorporated bicaval cannulation and vertical transseptal incision extended into the roof of LA. From the first operation it became clear that this approach was superior to all others we had used during 20 years, since it gives perfect visibility of mitral valve, does not require retractors (only traction sutures are applied) and allows even to very easily use the continuous suture for valve fixation. Size of LA is no longer important.(ABSTRACT TRUNCATED AT 250 WORDS)