Comparison between inter atrial and trans-septal approach in mitral valve surgery (original) (raw)
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Mitral valve surgery: comparison between superior septal and left atrial approaches
University of Baghdad Medical College, 2021
Mitral valve surgery: comparison between superior septal and left atrial approaches Abdulsalam Y. Taha Abstract: Background Mitral valve (MV) is one of the most complex structures in human heart with a challenging exposure. Traditionally, MV is approached via left atriotomy (LAA) while superior septal approach (SSA) is an alternative. Objective: is to highlight the merits and demerits of these two approaches in providing access to the MV in term of the aortic cross clamp time (ACCT), quality of exposure, and potential complications in view of the published literature. Patients and Method: Over an 18-month period ending at June 30 th , 2019, 56 patients with MV disease ± other cardiac diseases were enrolled in this study. Twenty patients had surgery via LAA (one surgeon) whereas 36 were operated upon via SSA (another surgeon). Standard surgery was done via median sternotomy, cardiopulmonary bypass and hypothermia of 32 0 C. Perioperative events were recorded. Results In SSA group (ma...
Surgical approaches to the mitral valve: variable paths to the same destination
Indian Journal of Thoracic and Cardiovascular Surgery, 2017
Surgical exposure to access mitral valve has been performed through various chambers in the heart like left atrium, right atrium and trans septal approach, through ascending aorta and left ventricle as well. Depending upon the surgical pathology, body habitus of the patient, and previous cardiac surgery, each approach has some advantages and disadvantages. This article reviews all the approaches and the surgical indications as well the advantages and disadvantages of the each approach.
International Journal of Medical Arts (Print), 2021
Background: Cardiac surgery became more common. This led to increased redo-surgeries with expected increase of overall complications after the redo. The used approach could affect overall outcome. However, this is not addressed well in literature. Aim of the work: To examine the overall outcome of patients underwent redo-mitral valve replacement [redo-MVR]. Patients and methods: This study is a retrospective comparative study that was conducted in Cardiothoracic Surgery Department, Al-Hussein University Hospital in the last three years [from January, 1st, 2017 to the end of December 2019]. Collected data included patient demographics, surgical approach and overall short-term outcome. Results: The current study included 37 patients; the mean age was 45.19±9.16 years. The most common indication for redo was pannus formation [48.6%], followed by thrombosis [45.9%]. There was no significant difference between preoperative and postoperative heart rhythm. Redo sternotomy was the commonest, reported in all patients, and femoral bypass done for 3 patients. Trans-atrial approach reported in 24 patients [64.86%] while Trans-septal approach reported in 13 patients [35.14%]. No significant difference between preoperative and postoperative echo data [Ejection Friction, left atrial dimension or left ventricle end diastolic dimension]. However, there was significant reduction of left ventricle end-systolic dimension [LVESD], pulmonary artery systolic pressure [PASP] and pressure gradient [PG] cross mitral valve after operation. Reoperation for bleeding was not reported in any cases, while need for new pacemaker reported in 2 patients [5.41%], new postoperative neurological dysfunction reported in new heart failure or need to dialysis in two patients [5.41%]. The postoperative arrhythmia was reported in 7 patients [18.9%] and mortality was occurred in three patients [10.8%]. Conclusion: The results of the current study showed that, both transseptal and transatrial approaches are comparable and no one is superior to the other.
Mitral valve repair: beyond the French correction
Hellenic journal of cardiology : HJC = Hellēnikē kardiologikē epitheōrēsē
We analysed retrospectively patients who underwent mitral valve repair using techniques beyond the "French correction", as popularised by Carpentier. From June 1997 to June 2006, 153 patients underwent mitral valve repair. Their mean age was 63.1 +/- 13.5 years (range 19-87). Mean Euroscore was 4.9 +/- 2.1 (2-13). Type II lesions were present in 109 cases. There were 123 degenerative cases. Preoperative mitral regurgitation (MR) was severe in 145 cases. Ninety patients were in NYHA class III/IV. The transseptal approach was employed in 89.5% of the series. Annuloplasty alone was performed in 36 patients, whereas leaflet plication/exclusion was applied in 53 patients. The edge-to-edge technique was used in 79. Mitral valve repair was combined with procedures for ischaemic heart disease in 41 patients. The mean postoperative stay was 8.1 +/- 3.7 days (4-25). There was no mortality in the isolated mitral valve repair group. New onset atrial fibrillation occurred in 17% postop...
Background: The lack of evidence on postoperative outcomes using mitral valve approaches leaves the choice 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, res...
Journal of Cardiothoracic Surgery
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 patien...
Interactive cardiovascular and thoracic surgery, 2017
The purpose of the study was to test whether a beating heart mitral valve operation was a valuable option in a heterogeneous group of patients considered very high risk for conventional mitral valve surgery. We conducted a retrospective, single-centre, observational cohort study of 120 patients (mean age 63.7 ± 12.1 years, range 25.3-88.8 years; mean logistic EuroSCORE 26.1 ± 20.6%, range 1.5-84.3%) undergoing beating heart mitral valve operations using normothermic cardiopulmonary bypass without aortic cross-clamping and without cardioplegia between September 2002 and April 2014. Preoperatively, 14 (11.7%) patients were in cardiogenic shock, 16 (13%) on a ventilator, 33 (27.5%) receiving inotropic support, 12 (10%) on dialysis and 1 on extracorporeal membrane oxygenation. Sixty-five (54%) patients had had at least 1 (range 1-6) previous heart operation. The mean follow-up period was 920 ± 973 days. A mitral valve procedure was performed alone in 75 (62.5%) patients and combined wit...
Minimally invasive mitral valve repair suggests earlier operations for mitral valve disease
The Journal of Thoracic and Cardiovascular Surgery, 2003
We began minimally invasive mitral valve surgery in August, 1996, to reduce hospital costs, to improve patient recovery, cosmetic appearance, and to decrease trauma, yet maintain the same quality of surgery. To validate this approach we reviewed our entire experience through May 2002. Methods: From August 1996 to May 2002, we performed 413 minimally invasive mitral valve operations including 51 mitral valve replacements and 362 mitral valve repairs. Excluding 4 robotically assisted repairs, we evaluated 358 patients, using the mitral valve repairs as the basis for this retrospective survey. These operations were performed through a 6-to 8-cm minimally invasive incision, beginning with parasternal and, most recently, lower ministernotomy (181 patients). The mitral valve reparative techniques include repair of 94 prolapsed anterior leaflets, posterior leaflet resection, leaflet advancement, commissuroplasty, Polytetrafluoroethylene (PTFE; Gore-Tex, W. L. Gore & Associates, Inc, Flagstaff, Ariz) chordal placement, and ring annuloplasty. Cannulation sites varied but primarily utilized a miniaturized system of 24F catheters in both the inferior and superior venae cavae with assisted venous suction. The Cosgrove ring was used in 95% of the patients undergoing this procedure. Results: The operative mortality was 0/358. Perioperative morbidity included a 26% incidence of new atrial fibrillation, 2% incidence of pacemaker implantation, 0.5% incidence of deep sternal wound infection, and 1.9% incidence of stroke after an operation. There were 10 arterial and 3 venous complications. The mean length of stay was 6 days and 208 patients stayed Յ5 days. Only 25% of the patients underwent homologous blood transfusion. The mean follow-up was 36 months with 1.4% lost to follow-up. There were 12 late deaths and a survival at 5 years of 95%. There were 21 valves requiring reoperation for structural valve failure of 5.8%. The probability of freedom from reoperation at 5 years was 92%. Conclusion: This study documents the safety of minimally invasive mitral valve repair surgery in 358 patients. It also documents a low incidence of homologous blood use, requirement for post-hospital rehabilitation, and general morbidity.
Several new considerations in mitral valve repair
The Journal of Heart Valve Disease, 2004
Background and aim of the study: A retrospective evaluation was made of a small personal series of patients undergoing mitral valve repair in order to address four contemporary questions: (i) What is the best method of achieving a stable repair in mitral valve prolapse?; (ii) How should patients with pure annular dilatation without prolapse or antecedent ischemia be categorized?; (iii) Are valve procedures in ischemic mitral regurgitation (MR) still associated with less satisfactory early and late outcomes?; and (iv) Is prophylactic amiodarone therapy safe and effective in reducing postoperative arrhythmias? Methods: Between 1993 and 2002, a total of 118 patients with non-rheumatic MR undergoing isolated mitral valve repair with or without coronary bypass was analyzed retrospectively: of these patients, 66 had prolapse (Group I), 21 had pure annular dilatation (Group II), and 31 had ischemic MR (Group III). All three groups routinely underwent Carpentier ring annuloplasty. Twenty-three patients in Group I were managed with leaflet resection and reconstruction (LRR), but in 1996 the technique for Group I was changed to uniform artificial chordal replacement (ACR) and no leaflet resection (n = 43). Also in 1996, prophylactic amiodarone therapy was first used routinely, and postoperative arrhythmia data were compared to those from prior patients. Baseline and outcome variables were assessed for each group and compared between the three groups. Survival data were evaluated using the Cox proportional hazards model. Results: Significant differences in baseline characteristics were observed: Group II was predominantly female; Group III more often experienced acute presentation; and Groups II and III had more comorbid disorders and left ventricular dysfunction (all p < 0.01). ACR was highly successful for repair of prolapse, and no ACR patient exhibited significant residual MR or outflow tract obstruction. Operative mortality and morbidity were low in all groups, and ischemic etiology failed to be an independent predictor of early or late adverse outcome (p > 0.10). Cox model analysis to nine years of follow up (median 4 years) identified only advanced age and number of comorbidities as influencing late mortality (both p < 0.03). Over the follow up period, 8.7% of LRR patients required reoperation for valve failure due to late chordal rupture, whereas none of the ACR patients failed. Finally, prophylactic amiodarone significantly reduced postoperative arrhythmias (p = 0.03) with no observed complications, and also eliminated death due to arrhythmia. Conclusion: Ischemic etiology may be diminishing as an independent risk factor in Group III, at least partially because of uniform valve repair. Group II comprised a distinct entity of females with higher comorbidity, and prophylactic amiodarone therapy seemed useful as a routine measure. Finally, ACR appeared to produce a stable repair in virtually all Group I patients, suggesting that prolapse might be appropriately managed with ring annuloplasty and uniform ACR. However, future studies are suggested for further consideration of these hypotheses.