Left Atrial or Transeptal Approach for Mitral Valve Surgery: A Systematic Review and Meta-analysis

Harky, Amer; Kusu-Orkar, Ter-Er; Chan, Jeffrey Shi Kai; Noshirwani, Arish; Savarimuthu, Sugeevan; Pousios, Dimitrios; Muir, Andrew D

doi:10.1016/j.cpcardiol.2020.100602

Cited by 9 publications

(2 citation statements)

References 23 publications

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“…Analysis of the isolated MV surgery subgroup did not show any signi cant difference. Unlike our study, the distribution of other concomitant valve procedures was not symmetrical and this could in uence the higher incidence of postoperative rhythm disorders and the need for PPM (22) The high mortality rate observed in both intervention groups is striking. However, it should be taken into account that both isolated mitral procedures and procedures combined with valve interventions in other locations and / or with coronary revascularization have been included in the present analysis.…”

Section: Discussioncontrasting

confidence: 88%

Atrial Approach in Mitral Valve Surgery: Are There Differences in the Incidence of Clinically Relevant Adverse Effects? A Propensity Analysis.

Obando

Garzón

Ramirez

et al. 2021

Preprint

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Background: The lack of evidence with respect to complications with mitral valve approaches leaves the choice of exposure to the surgeon’s preference, basing it on individual experience, speed, ease, and quality of exposure. Methods: Analysis of patients undergoing mitral valve surgery by either a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first time elective mitral valve procedures, isolated or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. Primary endpoint was to determine the association between the superior transeptal approach and clinically significant adverse outcomes including arrhythmias, need for permanent pacemaker, cerebrovascular events, and mortalityResults: 652 patients met the inclusion criteria, 391 received the left atrial approach and 261 superior transseptal. After matching, 96 patients were compared with 69, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias and the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, however the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period, and in the long-term follow-up.Conclusion: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome, therefore we consider that the superior transeptal approach is useful and safe for mitral valve exposure.

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Section: Discussioncontrasting

confidence: 88%

Atrial Approach in Mitral Valve Surgery: Are There Differences in the Incidence of Clinically Relevant Adverse Effects? A Propensity Analysis.

Obando

Garzón

Ramirez

et al. 2021

Preprint

View full text Add to dashboard Cite

show abstract

“…Analysis of the isolated MV surgery subgroup did not show any significant difference. Unlike our study, the distribution of other concomitant valve procedures was not symmetrical, which could influence the higher incidence of postoperative rhythm disorders and the need for PPM [21].…”

Section: Pad Peripheric Arterial Diseasecontrasting

confidence: 83%

Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects

Obando

Garzón

Ramirez

et al. 2022

J Cardiothorac Surg

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Background The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon’s preference, based on individual experience, speed, ease, and quality of exposure. Methods The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality. Results A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up. Conclusion We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.

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A simple transseptal approach versus the conventional left atrial approach for mitral valve procedures: a retrospective study

Mostafa,

ELminshawy,

Allam

et al. 2023

Indian J Thorac Cardiovasc Surg

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Left Atrial or Transeptal Approach for Mitral Valve Surgery: A Systematic Review and Meta-analysis

Cited by 9 publications

References 23 publications

Atrial Approach in Mitral Valve Surgery: Are There Differences in the Incidence of Clinically Relevant Adverse Effects? A Propensity Analysis.

Atrial Approach in Mitral Valve Surgery: Are There Differences in the Incidence of Clinically Relevant Adverse Effects? A Propensity Analysis.

Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects

A simple transseptal approach versus the conventional left atrial approach for mitral valve procedures: a retrospective study

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