Transversal trans-septal biatrial approach for mitral valve surgery

A surgical approach to the mitral valve is very important to visualize all valvular and subvalvular structures. We have used a transversal trans-septal biatrial approach in some mitral procedures. From January 1994 to May 1994, 11 patients were operated on using this technique. Patient ages ranged from 28 to 74 years. Five cases (45.5%) were cardiac reoperations and six (54.5%) were first operations. Three case (27.3%) were mitral reconstructions, 3 (27.3%) were mitral replacement due to mechanical mitral valve thrombosis, 1 (9.1%) as a result of bioprosthetic mitral valve degeneration, 4 (36.4%) were mitral valve replacements for calcified mitral valve disease one case (9.1%) was tricuspid valve replacement due to severe tricuspid insufficiency. There were 4 case (36.4%) of tricuspid valvuloplasties besides the mitral procedures. There was no operative mortality, and all patients preserved their preoperative cardiac rhythm. No important bleeding or supra-ventricular arrhythmias were seen in any case. Aortic cross-clamping and extracorporeal circulation times were comparable with the traditional approach through the left atrial alone. So, we think that this is a very easy and useful technique to expose the mitral valve during some procedures above it, overall when the left atrium is small and total visualization of the mitral is not possible with the traditional approach through the left atrial alone.