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

Mujtaba, Syed Saleem and Clark, Stephen (2018) Extended trans-septal versus left atrial approach in mitral valve surgery: 1017 patients’ experience. Heart Asia, 10 (2). e011008. ISSN 1759-1104

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


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.

Item Type: Article
Subjects: B100 Anatomy, Physiology and Pathology
Department: Faculties > Health and Life Sciences > Applied Sciences
Depositing User: Becky Skoyles
Date Deposited: 26 Nov 2018 12:26
Last Modified: 11 Oct 2019 14:32
URI: http://nrl.northumbria.ac.uk/id/eprint/36913

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