Combined superior-transseptal approach to the mitral valve

Arsiwala, Saify; Parikh, Prashant; Dixit, Snehal; Agney, Manoj; Kole, Shrikant D; Saksena, Devendra

doi:10.1016/0003-4975(92)90790-b

Cited by 7 publications

(3 citation statements)

References 3 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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“…The cephalad extension should be aiming between SVC and pulmonary vein but short of it to avoid damage to the LA roof. This also has not been noted in our series; delayed rhythm disturbances as noted by Arsiwala 11 , have also not been seen in a group of patients.…”

Section: Discussionmentioning

confidence: 53%

Comparative Results of Repair of Ischemic Mitral Regurgitation (IMR): Conventional against Trans-Septal Approach

Memon¹,

Ansari²,

Khan³

et al. 2017

Int. j. endorsing health sci. res.

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Objective Ischemic mitral regurgitation is common and increases mortality, even when mild. (American Heart Association) AHA and European association have both stressed the need of mitral valve repair in patients with moderate or more regurgitation. The aim of this study was to compare the results with the conventional and right atrial trans-septal approach of mitral valve repair in Ischemic Mitral Regurgitation (IMR). Methodology A total of 308 consecutive patients underwent mitral valve repair for IMR, between January 2012 and December 2013 at Tabba Heart Institute. Patients who had at least moderate mitral regurgitation or more mitral regurgitation underwent mitral regurgitation repair. The final decision of mitral valve repair was taken after the intra operative trans-esophageal echocardiography (TEE). Result Total number of patients included in study was222, out of those 153 (69.9%) patients underwent conventional approach and 69 (31.1) patients underwent trans-septal approach. Total 88.2% patients got off bypass in normal sinus rhythm in conventional approach group, as compared to 82.1% in transseptal group. 11.8% and 17.9% patients got off by pass on pacing in conventional and transseptal approach respectively. 3 patients developed junctional rhythm and 5 patients developed complete heart block in post-operative period in trans-septal approach. Conclusion Right Atrial Trans-septal technique is a good alternative approach that can be used in relatively small atria. It not only provides an excellent exposure to the mitral valve, there also seems to be no associated rhythm disturbances encountered as well.

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“…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%

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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Combined superior-transseptal approach to the mitral valve

Cited by 7 publications

References 3 publications

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

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

Comparative Results of Repair of Ischemic Mitral Regurgitation (IMR): Conventional against Trans-Septal Approach

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

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