Outcomes of transseptal approach in mitral valve surgery vs classic approach Download PDF

Introduction: In mitral valve surgery, there are several methods to approach left atrium: the classic approach through vertical interatrial groove, vertical transatrial septal, LA roof, and the classic approach of extending to the LA roof and the temporary vena cava division of the upper cavity. The aim of this study was to determine the effects of mitral valve surgery using transseptal approach in comparison with classic approach. Materials and Methods: In this retrospective study, all patients who underwent mitral valve surgery in the Tehran heart center during 2002 to 2012 were divided into two groups (classic and transseptal approaches). Patient's demographic information, electrophysiological findings before and after surgery, and complications of each surgical approaches were recorded. Findings: The mean age of subjects in the LA group was 35.5 ± 6.9 with the age range of 11-65 years and in the TS group the mean age of the patients was 32.2 ± 9.3 with the age range of 14-16 years. The LA group included 1078 patients, of which 280 (25.98%) were men and 798 (74.02%) were women. The TS group also included 270 patients, 73 of them (27.03%) were men and 197 (72.97%) were women. The results of this study showed no significant difference between the mean perfusion time (P = 0.354) and cross clamp (P = 0.213). The mean perfusion time in the classic approach was 77.1 ± 15 and in the transseptal approach was 78.5 ± 23 minutes. On the other hand, there was no significant difference between the two approach in terms of the need for pacemaker insertion and postoperative junctional rhythm between the two approaches (P = 0.425). There was a significant difference between the two surgical approaches in terms of the mean stay in the ICU (P = 0.362) and in the hospital (P = 0.779). The mortality rate was similar between the two groups (P = 0.62). Discussion and conclusion: The results of our study showed that the Transseptal approach does not produce destructive or lethal effects in comparison with the classic approach.