Superior transseptal versus left atriotomy approaches in isolated mitral valve surgeryCentral MessagePerspective
Zohaib R. Khawaja, BS,
Gabriel E. Cambronero, MD,
Yusuf M. Aboutabl, BS,
Elizabeth C. Wood, MD,
James E. Jordan, PhD,
Timothy E. Craven, MSPH,
Patrick M. Kozak, MD,
Prashant D. Bhave, MD,
Adrian L. Lata, MD,
Edward H. Kincaid, MD,
Neal D. Kon, MD,
Bartlomiej R. Imielski, MD
Affiliations
Zohaib R. Khawaja, BS
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC; Address for reprints: Zohaib R. Khawaja, BS, Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston-Salem, NC 27157.
Gabriel E. Cambronero, MD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Yusuf M. Aboutabl, BS
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Elizabeth C. Wood, MD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
James E. Jordan, PhD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Timothy E. Craven, MSPH
Department of Biostatistics and Data Science, Wake Forest University School of Medicine, Winston-Salem, NC
Patrick M. Kozak, MD
Division of Electrophysiology, Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC
Prashant D. Bhave, MD
Division of Electrophysiology, Department of Cardiology, Wake Forest University School of Medicine, Winston-Salem, NC
Adrian L. Lata, MD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Edward H. Kincaid, MD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Neal D. Kon, MD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Bartlomiej R. Imielski, MD
Department of Cardiothoracic Surgery, Wake Forest University School of Medicine, Winston-Salem, NC
Objective: The superior transseptal approach to mitral valve surgery offers improved exposure compared with left atriotomy; however, concerns remain regarding postoperative arrhythmias and pacemaker placement. This study investigates intraoperative parameters and postoperative outcomes in these approaches. Methods: Retrospective review of 259 adults undergoing isolated mitral valve repair or replacement over a 10-year period was performed. Exclusion criteria included previous history of permanent pacemaker placement and concomitant cardiac procedures. The primary outcome evaluated was postoperative permanent pacemaker placement. Secondary outcomes included postoperative new-onset atrial fibrillation, new-onset arrhythmias, major adverse cardiovascular events, length of stay, and mortality. Results: Of 259 surgeries, 116 were performed via left atriotomy and 143 via superior transseptal approach. The overall incidence of postoperative permanent pacemaker placement was 3.0%, with similar rates (left atriotomy 1.7% vs superior transseptal 4.2%, P = .30). The incidence of new-onset atrial fibrillation (31.0% vs 42.7%, P = .055) and arrhythmias in general (37.1% vs 49.0%, P = .06) was similar. Rates of other secondary outcomes, such as major adverse cardiovascular events and mortality, were similar between cohorts. In addition, cardiopulmonary bypass and aortic crossclamp times did not differ. Interestingly, intensive care unit (55 vs 73 hours, P = .04) and postoperative length of stay (6.8 vs 9.0 days, P = .002) were shorter after left atriotomy. Conclusions: The superior transseptal approach provides optimal exposure while preserving similarly low rates of postoperative morbidity and mortality to left atriotomy. There is no difference in the incidence of postoperative permanent pacemaker placement and new-onset arrhythmias.
