The Superior Approach to the Mitral Valve

Saksena, Devendra; Tucker, Bernard L.; Lindesmith, George G.; Nelson, Russell M.; Stiles, Quentin R.; Meyer, Bert W.

doi:10.1016/s0003-4975(10)65107-7

Cited by 31 publications

(6 citation statements)

References 8 publications

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“…Surgical access to the mitral valve through the left atrial roof (LAR) has been initially described by Meyer in 1965 as a variation of the vertical biatrial approach to the mitral valve. 5,6 In 2007, given the increased interest in minimally invasive surgery, the LAR approach was chosen at our institution as the preferential approach to repair or replace mitral valve.…”

mentioning

confidence: 99%

Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery

Esposito

Cappabianca

Bichi

et al. 2012

Innovations�(Phila)

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Objective The most common surgical incisions to expose the mitral valve include a paraseptal left atriotomy or a transeptal biatrial approach. Both techniques are normally performed through a full sternotomy and bicaval cannulation. We report our experience with an alternative incision to expose the mitral valve using the left atrial roof (LAR) through a complete sternotomy or a J-shaped upper ministernotomy. Methods Between 2007 and 2011, a total of 512 patients underwent mitral procedures using the LAR approach. A J-shaped ministernotomy was performed in 189 patients, and 61 of these had concomitant aortic valve/root procedures. A standard sternotomy was performed in 323 patients, and 126 of these had concomitant aortic valve/root procedures. The repair rate in patients with mitral regurgitation was 398 of 460 (86.5%). Results In-hospital mortality was 2.3%. An adjunctive pericardial patch to repair the LAR was necessary in 1.9% of patients. A permanent pacemaker was necessary in 3.1% of patients. Four-year survival rate was 91% ± 4.2%. In patients who underwent mitral repair, 4-year freedom from mitral regurgitation greater than 2 was 97.4%. Conclusions The LAR approach is a safe and effective option to perform mitral valve surgery. The limited extension of this incision and the possibility to use a single venous cannula make this approach suitable for minimally invasive isolated mitral valve procedures, whereas the proximity of the LAR to the aortic root makes this approach particularly attractive for combined mitroaortic procedures through a ministernotomy.

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mentioning

confidence: 99%

Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery

Esposito

Cappabianca

Bichi

et al. 2012

Innovations�(Phila)

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“…In 1965, Meyer was the first to describe this approach. Saksena et al, Molina, and Hirt et al favored the dome incision, describing it as "allowing adequate exposure of the mitral valve" [Hirt 1988;Molina 1988;Saksena 1971;Meyer 1965]. Larbalestier et al did not approve of this incision, describing it as being "not suitable for mitral valve repair" [Larbalestier 1992].…”

Section: Discussionmentioning

confidence: 99%

Left Atrial Roof Incision for Mitral Valve Interventions and Left Atrial Mass Resection: A Safe Alternative for Excellent Exposure. A Single Center Experience

Ahmed

Jawad

2018

HSF

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“…It has been associated with difficult and problematic closure because of its thin-walled nature in this location. [1][2][3] Another option is a right atriotomy with a transseptal approach ( Figure 2C). Unfortunately, exposure can be challenging through a small septal defect, and there is concern for injury to the atrioventricular node with excessive retraction.…”

Section: Discussionmentioning

confidence: 99%

“…This approach eliminates the need for excessive retraction on the right atrium and right ventricle. It has been associated with difficult and problematic closure because of its thin‐walled nature in this location 1–3 …”

Section: Discussionmentioning

confidence: 99%

Tricuspid Valve Replacement through a Left Atriotomy and Transseptal Approach in a Congenitally Malformed Heart

Kogon¹,

Grudziak²,

McConnell

et al. 2012

Congenital Heart Disease

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More and more children with congenital heart disease are surviving into adulthood. These patients are forcing adult congenital cardiac surgeons to develop innovative approaches to correct their complex anatomy and physiology. This report describes a patient with a congenitally malformed heart necessitating a novel approach to access the tricuspid valve--a left atriotomy and transseptal incision. Three-dimensional preoperative imaging allowed for successful surgical planning.

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The Superior Approach to the Mitral Valve

Cited by 31 publications

References 8 publications

Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery

Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery

Left Atrial Roof Incision for Mitral Valve Interventions and Left Atrial Mass Resection: A Safe Alternative for Excellent Exposure. A Single Center Experience

Tricuspid Valve Replacement through a Left Atriotomy and Transseptal Approach in a Congenitally Malformed Heart

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