Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 29;17(1):341.
doi: 10.1186/s13019-022-02058-4.

Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects

Carlos E Obando  1 , Javier D Garzón  2   3 , Lina M Ramirez  2 , Andrea C Castillo  2   4 , Albert F Guerrero  2   5 , Tomás Chalela  2 , Diana C Sandoval  2 , Manuel Giraldo-Grueso  6 , Nestor F Sandoval  2 , Jaime Camacho  2 , Juan P Umaña  2
Affiliations

Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects

Carlos E Obando et al. J Cardiothorac Surg. .

Abstract

Background: The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon's preference, based on individual experience, speed, ease, and quality of exposure.

Methods: The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality.

Results: A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up.

Conclusion: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.

Keywords: Cardiac surgical procedures; Complications; Mitral valve; Postoperative period; Surgical approaches.

PubMed Disclaimer

Conflict of interest statement

Dr Juan P. Umana is a consultant for Edwards Lifesciences.

Figures

Fig. 1
Fig. 1
Consort 2010 flow diagram
Fig. 2
Fig. 2
Standardised differences of the preoperative and perioperative variables before and after pairing by propensity scores
Fig. 3
Fig. 3
Kaplan–Meier survival curves
See this image and copyright information in PMC

References

    1. Goldstone AB, Woo YJ. Alternative approaches for mitral valve repair. Ann Cardiothorac Surg. 2015;4:469–473. - PMC - PubMed
    1. Sultan I, Trivedi I, Machiraju V. Surgical approaches to the mitral valve: variable paths to the same destination. Indian J Thorac Cardiovasc Surg. 2017;34(S2):105–112. doi: 10.1007/s12055-017-0598-7. - DOI
    1. Jouan J. Mitral valve repair over five decades. Ann Cardiothorac Surg. 2015;4:322–334. - PMC - PubMed
    1. Guiraudon GM, Ofiesh JG, Kaushik R. Extended vertical transatrial septal approach to the mitral valve. Ann Thorac Surg. 1991;52:1058–1062. doi: 10.1016/0003-4975(91)91281-Y. - DOI - PubMed
    1. Bashar Izzat M, Aljasem H, Alsharabi M. Comparison of safety and outcomes with two approaches of the mitral valve. J Card Surg. 2020;35(7):1458–1463. doi: 10.1111/jocs.14603. - DOI - PubMed