Comparison of outcomes with three atrial incisions for mitral valve operations

Abstract

We compared the preoperative status, operative factors, and postoperative outcomes among patients having mitral valve operations with three atrial incisions. The incisions were right lateral (n = 66), superior septal (n = 46), and transseptal (n = 37). Differences in patient and operative factors among the groups were not predictors of adverse postoperative outcomes with multiple regression analysis. Postoperative pulmonary failure was less common in the superior septal group. Patients in the superior septal group more commonly required permanent pacemakers than those in the right lateral group. In patients with sinus rhythm before operation, sinus rhythm had returned before hospital discharge more commonly in those in the right lateral group (35 of 44, 80%) than in those in the superior septal group (18 of 28, 46%) or in the transseptal group (9 of 13, 69%). With multiple regression analysis the type of atrial incision was not a predictor of postoperative pulmonary failure or need for permanent pacemaker. Right lateral and transseptal atrial incisions were predictors of retention of sinus rhythm after operation. We conclude that the results of superior septal incision are comparable with those of other incisions except for a slightly greater risk of loss of sinus rhythm. One must weigh the technical advantages of the superior septal incision against the risk of loss of sinus rhythm.

Multidetector CT imaging of arterial supply to sinuatrial and atrioventricular nodes

“…When the SANA supplies the SAN in precaval fashion by crossing the crest of the appendage, it is relatively safe with most standard incisions [7]. Use of the superior septal approach for mitral valve procedures is associated with cardiac rhythm disturbances due to intra-operative damage to the SANA [9,27]. The incidence of rhythm disturbance is high (52-60%) and, in some cases, pacemaker implantation is required [4,11].…”

Anatomical Aspects of the Arterial Blood Supply to the Sinoatrial and Atrioventricular Nodes of the Human Heart

“…3 Right lateral and transseptal 4 or combined superior-transseptal 5 atrial approaches for mitral valve procedures sometimes, but not always, have enabled the retention of sinus rhythm after surgery. 4,5 There is also a high risk (20 -37%) of early post-operative atrioventricular (AV) node block due to damage to the AV node artery during manipulation of the fibrous ring of the KEY WORDS: HUMAN HEART; CORONARY ARTERY; SINOATRIAL NODE; ATRIOVENTRICULAR NODE; ANATOMICAL VARIATIONS B Pejković, I Krajnc, F Anderhuber et al Anatomy of arterial blood supply to the heart mitral valve (annulus fibrosus). 6 In addition, ablation procedures in treating arrhythmias can result in complete AV block due to damage to the AV node artery.…”

Comparison between inter atrial and trans-septal approach in mitral valve surgery

“…9 One of the most issue concerned in cardiac surgery is the post-operative bleeding , in most of the studies the incidence post-operative bleeding is almost equal with slightly more prevalence in trans-septal approach, the usual site of bleeding is from the right atrial incision, the thin wall right atrium is more prone for bleeding than the thicker walled left atrium theoretically but our idea is if you close the atrium in 2 layers with fine stitches and if it is closed on arrested heart rather than beating heart then the risk of bleeding will be minimized. 10,11 The approach should be planned preoperatively, the preoperative medical history, the planned procedures, for example; deep chest, previous lung resection ,previous coronary bypass grafting (especially patent saphenous vein and mammary arteries), large or posterior sessile left atrial tumors, combined mitral/tricuspid access, left atrial clot, left ventricular hypertrophy secondary to calcific aortic stenosis, Kent bundle resection in WolffParkinson-White (WPW) syndrome, idiopathic hypertrophic subaortic stenosis (IHSS) with mitral valve replacement (MVR) and septal resection, redo mitral valve surgery, and more recently pain and cosmesis considerations, all these factors can help to take decision for either techniques or to use alternative approaches.…”