Objectives: The vertical transseptal approach has become popular because it offers
excellent exposure of the mitral valve and it is easy to close. Despite the excellent
view it affords, the vertical transseptal approach can result in postoperative sinus
node dysfunction and dysrrhythmias.
Methods: This prospective randomized study is to compare the postoperative
outcome-mainly arrhythmia- in patient who underwent isolated mitral valve
replacement using either minitransseptal approach or classic left atriotomy
approach. All mitral valve disease patients with sinus rhythm were selected for
this study. Patients with low EF, Ischemic mitral lesion and previous permanent
pacemaker were excluded.
Results: From June 2011 and July 2014 total120 patients with mitral valve disease
underwent elective mitral valve replacement (MVR). Group A had 56 patients
with a minitransseptal approach while group B had 64 patients with left atriotomy.
There was no statistically significant difference between both group regarding
preoperative and demographic data. No significant difference in Cross-clamp time
(96.0±15.9 min in Group A versus 89.4±21.1 min in group B, P value = 0.13) and
no difference in postoperative ventilation time (6.1±0.5 hours in Group A versus
5.0±0.2 hours in Group B, P value= 0.356). Three patients in Group A (5.36%)
re-opened for bleeding versus one patient (1.57%) in Group B with no significant
statistical difference, P value = 0.356. There was no significant difference in
hospital stay (14.4±5.4 days in Group A versus 13.3±1.9 days in Group B, P value
= 0.608. There was no statistical significance between the two groups regarding
the patients' rhythm during weaning off bypass, during the ICU stay or after
discharge. 15 Patients (27%) in group A while in group B 19 patients (29%)
showed AF of previous sinus rhythm postoperatively which was non statistically
significant.
Conclusion: Minitransseptal approach does not increase the postoperative
complications even postoperative arrhythmia when compared to classic left
atriotomy approach. Nowadays many centers used the transseptal approach as a
routine approach for mitral valve surgery. |
