Background: The optimal atrial approach for exposing the mitral valve with
optimized patient outcomes is still controversial. This study compared
conventional left atriotomy with the superior atrial approach for mitral valve
replacement (MVR).
Methods: A randomized clinical trial was conducted on 60 patients who
underwent MVR during the period 2022-2024. Patients were randomized into:
Group A (n= 30, left atriotomy) and Group B (n=30, superior atrial approach).
Results: The mean age in Group A was 43.17 ± 8.57 years, whereas that in Group
B was 47.63 ± 10.35 years (P = 0.07). No significant differences in sex, smoking
status or associated comorbidities were noted between the groups.
Echocardiographic findings revealed no significant differences in left ventricular
functions and dimensions. Preoperative laboratory data revealed no significant
differences in hemoglobin levels, platelet counts, or INRs. The total
cardiopulmonary bypass time was shorter in Group B than in Group A but did not
reach a significant level (P= 0.08). The cross-clamp times were significantly shorter
in Group B (64 ± 5.7 min) than in Group A (69 ± 9.5 min) (P = 0.02). There were no
differences in the rate of postoperative complications or duration of
hospitalization between the groups. Follow-up echocardiographic evaluations
revealed no significant difference between Group A and B in regarding ejection
fraction (β: -0.003, 95% CI: -0.04-0.03, P = 0.82). Similarly, the left atrial diameter
decreased significantly over time (β-0.05, 95% CI: -0.07- -0.03, P < 0.001), with no
significant difference between the groups (β: -0.11, 95% CI: -0.29- 0.06, P = 0.21). |
