Comparison of Superior Septal Approach with Left Atriotomy in Mitral Valve Surgery

Aydın, Ebuzer; Arslan, Akın; Ozkokeli, Mehmet

doi:10.5935/1678-9741.20140045

Cited by 14 publications

(9 citation statements)

References 18 publications

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“…Many authors noted the prolonged CPB time and crossclamp time for MVS with the STS approach. Aydın et al achieved 96.0 min and 83.4 min cross-clamp times with the STS and LA approaches (P = .003) and 128.3 min and 118.3 min CPB times with the STS and LA approaches (P = .02), respectively [Aydin 2014]. Similarly, Masuda et al found a longer cross-clamp time after the STS approach compared with the LA approach; however, they did not give a P value to evaluate the significance of the difference [Masuda 1996].…”

Section: Discussionmentioning

confidence: 99%

Comparison of Left Atriotomy and Superior Transseptal Approaches in Mitral Valve Surgery

Türkyilmaz

Kavala

2018

HSF

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Purpose: To compare the operative and post-operative outcomes of mitral valve surgery (MVS) with a superior transseptal (STS) approach and a left atriotomy (LA) approach. Methods: In a tertiary academic center, the charts of patients who underwent MVS between 2012 and 2016 were analyzed retrospectively. A total of 135 patients underwent MVS. Forty patients who underwent MVS with the STS approach were enrolled in the study as the STS group. In the same period, we selected 40 patients who underwent MVS with the LA approach to serve as the control group (LA group). Two groups were operated by the same surgeon. To minimize the bias related to the lack of randomization in this observational study, LA group patients were selected using propensity score matching. Results: According to the study design, the preoperative characteristics of gender, age, mitral valve stenosis, and mitral valve insufficiency were matched (P = .368, P = .920, P = .250 and P = .057, respectively). The cardiopulmonary bypass time was 91.2 ± 12.1 minutes in the superior transseptal group and 72.8 ± 6.4 minutes in the left atriotomy group (P < .001). Additionally, duration of clamp time was significantly shorter in the left atriotomy group (P < .001). Estimated blood loss was significantly less in patients with a left atriotomy (535.8 ml versus 658.0 mL, P < .001). Duration of intensive care unit stay and hospitalization time were significantly longer in patients who underwent the superior transseptal approach compared with patients who underwent left atriotomy (P < .001 versus P < .001, respectively). Post-operative dysrhythmia rate and mortality rate were similar between the groups. Conclusion: Our study demonstrated that MVS with LA decreased cardiopulmonary bypass time, duration of clamp time, amount of hemorrhage, duration of intensive care unit stay, and hospitalization time compared with MVS with STS.

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Section: Discussionmentioning

confidence: 99%

Comparison of Left Atriotomy and Superior Transseptal Approaches in Mitral Valve Surgery

Türkyilmaz

Kavala

2018

HSF

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“…However, other reports show that while a superior transseptal approach produces higher postoperative ejection fraction, it does not incur higher risk of arrhythmia compared to a left atriotomy. 6,7 The debate over a transseptal vs a left atrial approach is arguably sustained by the scarcity of data on the types of arrhythmias that arise after MV surgery. Currently, the phenotypes of conduction defects appear to be directly attributable to surgical lesions.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of intra‐atrial reentrant tachycardia following mitral valve surgery: Relationship to surgical approach

Gandhavadi

Cox

2020

J Card Surg

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Background and Aim Mitral valve (MV) surgeries create electrophysiological substrates that give rise to postoperative arrhythmias. MV surgical procedures have been associated with macro‐ and microreentrant arrhythmogenic circuits, as well as circuits involving the atrial roof. It is not well understood why such arrhythmias develop; therefore, the aim of this study was to describe clinical and procedure characteristics associated with atrial arrhythmias in patients with prior MV surgery. Methods This retrospective chart review evaluated patients who had prior MV surgery and ablation procedures for atrial tachycardia between 2014 and 2018 (n = 20). Patients were classified into those exhibiting typical atrial flutter or another atrial tachyarrhythmia. Results Within the 20 patient cases reviewed, 30 arrhythmias were documented. Two‐thirds of arrhythmias were typical atrial flutter; the percent incidence of arrhythmias originating in the right atrial (RA) roof, around the right atriotomy scar, in the left atrium, and at the crista terminalis was 20%, 3%, 7%, and 7%, respectively. Nearly every case of RA roof flutter (n = 5/6) and most arrhythmias (n = 20/30) occurred in patients who had a transseptal approach during MV surgery. Voltage maps did not show clear differences in scarring between groups. Conclusion Results from this study suggest that an arrhythmogenic substrate for RA roof tachycardias is generated by transseptal approaches for MV surgery. This substrate is not clearly related to a surgical scar. These data suggest that other approaches should be considered for MV surgeries. Additionally, more research is needed to determine the mechanism for this nonscar‐related arrhythmia substrate.

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“…The superior trans‐septal (STS) approach to the mitral valve was first described by Berreklouw et al 2 and Guiraudon et al, 3 and its efficacy in providing good exposure of the mitral valve has been established. The STS approach, however, has been blamed for longer cardiopulmonary bypass and ischemia times, 4,5 increased risk of bleeding, 6 and arrhythmias 7‐10 …”

Section: Introductionmentioning

confidence: 99%

Comparison of safety and outcomes with two approaches to the mitral valve

et al. 2020

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Background and aim The efficacy of the superior trans‐septal (STS) approach to the mitral valve has been offset by the perceived risks of adverse postoperative events. The aim of this study was to review our experience with using the left atriotomy (LA) and STS approaches in patients undergoing mitral valve surgery. Methods Charts of patients who underwent mitral valve surgery by a single surgeon over a period of 20 years were reviewed retrospectively. A total of 319 patients (aged 42.9 ± 16.2 years) were studied. Surgical operations were carried out through the LA approach in 111 patients, and through the STS approach in 208 patients. Results The two groups were comparable in terms of patients’ characteristics, but cardiopulmonary bypass and aortic cross‐clamp times were longer in the STS approach group (P = .0005). No technical complications related to either approach occurred. Rates of re‐exploration for postoperative bleeding, durations of intensive care unit (ICU) stay, in‐hospital days, and mortality were comparable in both approaches. Statistical analyses indicated that a patient was more likely to maintain a preoperative sinus rhythm if the LA approach rather than the STS approach was used (P < .05). On the other hand, when the preoperative heart rhythm was atrial fibrillation, no significant difference in perioperative changes in heart rhythm was observed between the two approaches. Conclusions This study confirms that the routine use of the STS approach is not associated with important adverse postoperative outcomes, but is associated with increased incidence of postoperative sinus node dysfunction in patients who were in sinus rhythm preoperatively.

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Comparison of Superior Septal Approach with Left Atriotomy in Mitral Valve Surgery

Cited by 14 publications

References 18 publications

Comparison of Left Atriotomy and Superior Transseptal Approaches in Mitral Valve Surgery

Comparison of Left Atriotomy and Superior Transseptal Approaches in Mitral Valve Surgery

Prevalence of intra‐atrial reentrant tachycardia following mitral valve surgery: Relationship to surgical approach

Comparison of safety and outcomes with two approaches to the mitral valve

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