*Corresponding author:Kenan Abdurrahman Kara, Department of Cardiovascular Surgery, Yeditepe University Hospital, Turkey
Received:October 4, 2018; Published: October 10, 2018
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There are various options to access the left atrium in surgical interventions performed on the mitral valve. Transapical approach is used to implant transcatheter valves for mitral bioprosthesis failure (valve in valve implantation) and implantation of artificial neo-chordae to correct mitral regurgitation [1,2]. It is also subsequently accessed through a standard left atriotomy incision from both left and right side of the atrium, superior or dome approach, right atriotomy (trans septal, superior septal, inferior trans septal, and extended trans septal approaches), trans aortic approach, and finally through the left ventriculotomy. Excellent visualization of the operative area is the key for a successful mitral valve surgery. Various clinical conditions and the body habitus of the patient do affect good surgical exposure, and the surgeon should be aware of all these approaches so that he can choose the right approach to a given patient. In this study, we offered superior septal approach as a second option particularly in cases where adequate exposure in small left atrium was hard to achieve with conventional left atriotomy.
Patients and Methods: 20 patients underwent mitral valve replacement operation using cardiopulmonary bypass (CPB) by a single surgeon between March 2017 - November 2017 at the Hisar Intercontinental Hospital. 20 patients (6 males, 14 females; mean age: 53.8) underwent MVR, and 6 of them had additional CABG, Tricuspit De Vega, and left atrial thrombus extraction operation using superior septal approach (Table 1).
Results: There were 14 women and 6 men. None of the patients had ischemic mitral valve regurgitation, 12 had mitral valve prolapse, and 8 had rheumatic heart disease. The mitral valve was replaced in all patients. 6 patients bioprosthesis valve and mechanical replacement in 14. There were no perioperative complications associated with the atriotomies, i.e. no bleeding, no atrioventricular nodal dysfunction, and no sinus node dysfunction. The extended vertical transatrial septal approach provides good mitral valve exposure without inherent complications.
Conclusion: In surgeries performed with the superior septal approach which we used in our study, it provides a good exposure in cases where the left atrium is particularly small. It is evident that using consecutive right atrium, fossa ovalis and left atrial dome incisions and closing these incisions in the appropriate anatomical position instead of reaching the mitral valve with a single left atriotomy increase the cross-clamp time. However, considering the loss of time and risk of complication in cases where adequate exposure cannot be achieved with the conventional left atriotomy, we think that this is an approach that should be in the repertoire of the surgeon as a quite good option.
Keywords : Mitral valve surgery; Superior septal approach; Exposure for mitral valve surgery