Postoperative cardiac rhythms with superior septal approach and lateral approach to the mitral valve

Masuda, Mitsuharu; Tominaga, Ryuji; Kawachi, Yoshito; Fukumura, Fumio; Morita, Shigeki; Imoto, Yutaka; Toshima, Yoshihiro; Tomita, Yukihiro; Yasui, Hirofumi

doi:10.1016/0003-4975(96)00379-7

Cited by 21 publications

(12 citation statements)

References 12 publications

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“…The sinus node (SN) function and atrial vulnerability after surgery still remain as important considerations with the STA, since the technique involves transecting the SN artery as well as the anterior internodal conduction pathway. While there are a number of published studies in favor of STA in the literature [ 1 - 3 , 5 , 12 , 13 ] , many studies reporting potential concerns regarding the SN dysfunction and atrial vulnerability during postoperative period are available [ 7 , 10 , 14 , 15 ] . In a study including 52 patients who underwent mitral valve surgery through STA, the authors reported that the number of the patients with sinus rhythm and atrial fibrillation were equal preoperatively.…”

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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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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“…In mitral valve surgery, the approach to LA influences the quality of the operation, especially in difficult anatomical situations such as a small LA, pericardial adhesions in reoperations, a deep thorax, dilated right cardiac chambers, or technically difficult operations including mitral valve repair. 1 –10 The combined superior-transseptal approach facilitates improved expose to the mitral valve apparatus in these situations. However, in our experience, this approach has drawbacks including large incisions cutting long sections of atrial muscle, and a complex closure process.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown the effects of this approach on sinus node function and postoperative arrhythmias. 6 –8 The modified LA approach avoids these problems, presumably by protecting a significant portion of atrial muscle.…”

Section: Discussionmentioning

confidence: 99%

Improved Combined Superior-Transseptal Approach to the Mitral Valve

Nguyen

2009

Asian Cardiovasc Thorac Ann

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In mitral valve surgery, the combined superior-transseptal approach gives excellent exposure of the mitral valve, but it is lengthy and complex. A modified version of this approach was made without cutting the right atrial appendage and the dome of the right atrium. This shorter procedure was evaluated in 30 patients aged 4-61 years undergoing complex mitral valve operations including mitral repair (33.3%), reoperation (30%), and small left atrium (30%). The mitral valve was exposed well in all cases. Because of the shorter incision, closure was relatively easy. The aortic crossclamp time was 117 +/- 29.9 min (range, 53-173). There were no major complications. Cardiac rhythm resumed spontaneously after release of the aortic clamp in 93.3% of patients, including 36.7% who regained sinus rhythm from arrhythmia preoperatively. There was no heart block, bleeding, or mortality. Results at 3 months were good. Despite a decreased operative field, this modified approach provided adequate exposure for all the required techniques. The benefits of this approach are a shorter incision in the atrial muscle, and simplified closure technique.

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“…In a nonrandomized study of 152 patients, Masuda and colleagues compared the Berreklouw and Guiraudon superior transseptal approach with conventional left atriotomy. They found that 96% of LA patients (n = 24) with preoperative sinus rhythm remained in sinus rhythm postoperatively compared with 78% of superior transseptal patients (n = 18), which was not statistically significant 9 . This finding suggested that the superior transseptal approach, which requires a more extensive incision than transseptal approach, may have a higher incidence of new, early postoperative arrhythmias but that the incidence of new arrhythmias in the long‐term was similar to the LA approach.…”

Section: Discussionmentioning

confidence: 91%