A simple transeptal approach versus the conventional left atrial
approach for mitral valve procedures: retrospective cohort study.
Abstract
Background: Having good exposure to the mitral apparatus during mitral
valve replacement is a vital decision every cardiac surgeon must take.
This study was conducted to compare the Simple Transseptal approach and
the conventional Left Atrial approach for mitral valve procedures, to
evaluate the safety and efficacy of the simple transseptal approach
during open-heart mitral valve procedures, as the conventional left
atrial approach may not provide optimal exposure, especially in
unfavorable anatomical and operative situations. Methods: This is a
retrospective chart review cohort study. It has been conducted on 140
patients who were diagnosed with heart diseases that required mitral
valve replacement. Surgeries were performed in Cardiothoracic Surgery
Department at Assiut University Hospital over the period from January
2016 to June 2021 by one surgeon. Mitral procedure was done through
median sternotomy incision under general anesthesia on cardiopulmonary
bypass machine with cold antegrade cardioplegia. Demographic data,
preoperative diagnosis, intraoperative findings, hospital stay,
complications, and mortality were documented and revised. Results: one
hundred and forty patients were enrolled in this study with a median age
of 39 years, and no significant differences as regards the baseline
demographic data as age, sex, and BMI. 68 patients underwent mitral
valve replacement through the simple transseptal approach and 72
patients through the conventional left atrial approach. Both studied
groups had insignificant differences as regards bypass time,
re-operation rate, postoperative complications, hospital stay, and
mortality. Conclusion: Simple transseptal approach through the midpoint
of fossa ovalis could be a safe and even favorable alternative to the
traditional left atriotomy approach in certain difficult operative
situations during mitral valve replacement surgery.