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Extended trans-septal versus left atrial approach in mitral valve surgery: 1017 patients' experience

Lookup NU author(s): Stephen Clark

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Abstract

© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted. Objective The mitral valve may be accessed directly through the left atrium but visualisation can sometimes be challenging. A trans-septal interatrial approach provides better exposure and easy access for concomitant tricuspid procedures especially in difficult cases. This retrospective study evaluates the safety and effectiveness of the extended vertical trans-septal approach (EVTSA) for routine mitral valve exposure. Method 1017 consecutive patients undergoing an isolated primary mitral valve procedure (repair/replacement) through a median sternotomy were retrospectively studied between 2000 and 2015. Up to 135 patients were operated by EVTSA (group A) while 882 patients underwent a traditional left atrial (LA, group B) approach. Results There were 135 patients (M/F=56/79) in group A and 882 patients (M/F=398/484) in group B. Logistic EuroSCORE was significantly lower in EVTSA group (0.61 vs 0.90, p=0.000001). In the LA group there were more patients with preoperative transient ischaemic attack or stroke (94 vs 6, p=0.005). Cumulative cross-clamp time was 82 (44-212) min (EVTSA group) and 78 (30-360) min (LA group) (p=0.271) while cardiopulmonary bypass time was 107 (58-290) and 114 (43-602) min, respectively (p=0.121). Postoperative blood loss was 415 mL (EVTSA) vs 427 mL (LA) (p=0.273). No significant difference was found in the incidence of postoperative atrial fibrillation (p=0.22) or heart block requiring permanent pacemaker (p=0.14). Conclusion In our opinion, EVTSA to the mitral valve is safe and reproducible. It gives excellent exposure of the mitral valve under all circumstances without any significant increase in cross-clamp or bypass time, postoperative arrhythmia, heart block/pacemaker rate or bleeding.


Publication metadata

Author(s): Mujtaba SS, Clark SC

Publication type: Article

Publication status: Published

Journal: Heart Asia

Year: 2018

Volume: 10

Issue: 2

Print publication date: 01/05/2018

Online publication date: 12/06/2018

Acceptance date: 26/04/2018

ISSN (electronic): 1759-1104

Publisher: BMJ Publishing Group

URL: https://doi.org/10.1136/heartasia-2018-011008

DOI: 10.1136/heartasia-2018-011008


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