Improved Combined Superior-Transseptal Approach to the Mitral Valve

Nguyen, Huu Uoc

doi:10.1177/0218492309103308

Cited by 5 publications

(5 citation statements)

References 11 publications

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“…Significantly more patients in the STS approach group in the present study required additional operative interventions, and this accounted for the longer cardiopulmonary bypass and aortic cross‐clamp times in this group. Likewise, this study confirms the findings of previous reports that mortality rates associated with both approaches were comparable 1,11 …”

Section: Discussionsupporting

confidence: 92%

“…Likewise, this study confirms the findings of previous reports that mortality rates associated with both approaches were comparable. 1,11 Concern continues about the STS approach leading to increased incidence of developing postoperative sinus node dysfunction or rhythm disturbances, [12][13][14][15] such as atrioventricular block, atrial flutter, or fibrillation, 4 supraventricular and junctional dysrhythmias, 9 and a higher incidence of permanent pacemaker insertion. 16 Our study confirms the presence of a significant relationship between the operative approach and sinus node dysfunction, and that patients with preoperative sinus rhythm were more likely to lose their normal sinus rhythm when the STS approach was used.…”

Section: Discussionmentioning

confidence: 99%

“…Good exposure of the mitral valve is necessary for success in mitral valve surgery. The traditional left atriotomy (LA) approach may sometimes be unable to allow sufficient visualization and access, especially in unfavorable circumstances such as small left atria, presence of mitral annular calcifications or redo operations 1 . 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.…”

Section: Introductionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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

et al. 2020

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“…Despite possible drawbacks including increased ischemia time, length of hospital stay, CPB, cross-clamp time, and increased bleeding related to the procedure, as previously mentioned, some authors reported no significant difference between the study groups [ 18 , 19 ] . In line with the literature, we observed no significant differences in the amount of bleeding, re-operation, and the length of hospital and ICU stay between the groups in our study.…”

Section: Discussionmentioning

confidence: 99%

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

Aydın¹,

Arslan²,

Ozkokeli³

2014

Revista Brasileira De Cirurgia Cardiovascular

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Objective In this study, we aimed to compare clinical outcomes of superior transseptal approach with the conventional left atriotomy in patients undergoing mitral valve surgery.Methods Between January 2010 and November 2012, a total of 91 consecutive adult patients (39 males, 52 females; mean age: 54.0±15.4 years; range, 16 to 82 years) who underwent mitral valve surgery in the Division of Cardiovascular Surgery at Koşuyolu Training Hospital were included. The patients were randomized to either superior transseptal approach (n=47) or conventional left atriotomy (n=44). Demographic characteristics of the patients, comorbidities, additional interventions, intraoperational data, pre- and postoperative electrophysiological study findings, and postoperative complications were recorded.Results Of all patients, 86.7% (n=79) were in New York Heart Association Class III, while 12 were in New York Heart Association Class IV. All patients underwent annuloplasty (42.9%) or valve replacement surgery (57.1%). There was no significant difference in pre- and postoperative electrocardiogram findings between the groups. Change from baseline in the cardiac rhythm was statistically significant in superior transseptal approach group alone (P<0.001). There was no statistically significant difference in mortality rate between the groups. Permanent pacemaker implantation was performed in 10.6% of the patients in superior transseptal approach group and 4.5% in the conventional left atriotomy group. No statistically significant difference in bleeding, total length of hospital and intensive care unit stay, the presence of low cardiac output syndrome was observed between the groups.Conclusion Our study results suggest that superior transseptal approach does not lead to serious or fatal adverse effects on sinus node function or atrial vulnerability, compared to conventional approach.

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“…Calcifications around the mitral valve ring and hypertrophic right ventricle may contribute to the narrowness of the left atrium. Additionally, scars and adhesions lead to mobility loss in the mitral valve and surrounding tissues and make surgery more challenging [Orhan 2000;Nguyen 2009]. Because of the factors mentioned above, obtaining an adequate view of the mitral valve is mandatory.…”

Section: Introductionmentioning

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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Improved Combined Superior-Transseptal Approach to the Mitral Valve

Cited by 5 publications

References 11 publications

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

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

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

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

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