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Comparative Study
. 2025;31(1):25-00095.
doi: 10.5761/atcs.oa.25-00095.

Does the Superior Septal Approach Increase the Incidence of Postoperative Junctional Rhythm Compared to the Right-Sided Left Atriotomy?: A Comparison in Minimally Invasive Mitral Valve Surgery via Right Mini-Thoracotomy

Masataka Yamazaki  1 , Yorihiko Matsumoto  1 , Tatsuo Takahashi  1 , Hirofumi Haida  1 , Naritaka Kimura  1 , Kenichi Hashizume  1 , Hideyuki Shimizu  1
Affiliations
Comparative Study

Does the Superior Septal Approach Increase the Incidence of Postoperative Junctional Rhythm Compared to the Right-Sided Left Atriotomy?: A Comparison in Minimally Invasive Mitral Valve Surgery via Right Mini-Thoracotomy

Masataka Yamazaki et al. Ann Thorac Cardiovasc Surg. 2025.

Abstract

Purpose: The superior septal approach offers improved mitral valve exposure compared to the right-sided left atriotomy or transseptal approach. However, the risk of postoperative sinus node dysfunction remains controversial, with limited data in the context of right mini-thoracotomy.

Methods: This retrospective study included 155 patients (64 women; mean age, 60.8 ± 13.4 years) who underwent mitral valve surgery via right mini-thoracotomy between November 2016 and August 2023. Indications included degenerative mitral regurgitation (94.8%) and mitral stenosis (5.2%). Patients were divided into 2 groups: the conventional minimally invasive mitral valve surgery (CM) group (n = 47), using the right-sided left atriotomy, and the drawer-case technique (DCT) group (n = 108), using the superior septal approach. Demographic, intraoperative, and outcome data were analyzed.

Results: Baseline characteristics were similar between groups. There were no significant differences in valve repair techniques or postoperative echocardiographic findings. Postoperative junctional rhythm occurred in 6 patients (CM group) and 21 patients (DCT group); all patients with preoperative sinus rhythm returned to sinus rhythm postoperatively.

Conclusion: The superior septal approach does not increase the risk of persistent junctional rhythm in right mini-thoracotomy and is a safe and effective option for mitral valve surgery.

Keywords: drawer-case technique; junctional rhythm; minimally invasive mitral valve surgery; superior septal approach.

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Figures

Fig. 1
Fig. 1. The mitral valve exposed by the DCT approach is in close proximity to the chest wall and is accessible within finger’s reach. DCT: drawer-case technique
Fig. 2
Fig. 2. The aortic root and left atrial roof are captured in the center of the surgical field (white arrow: incision line for DCT; white asterisk: pushed up ascending aorta). DCT: drawer-case technique
See this image and copyright information in PMC

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