Conventional left atrial versus superior septal approach for mitral valve replacement.
BACKGROUND
This study was designed to evaluate the safety and effectiveness of the superior septal approach for routine mitral valve replacement.


METHODS
One hundred forty-six consecutive patients undergoing mitral valve replacement at our institution were randomly assigned to undergo the procedure using either the conventional left atriotomy or the superior septal approach. Postoperatively and during the follow-up, 12-lead electrocardiography, 24-hour Holter monitoring, and transthoracic and transesophageal echocardiography were performed in all patients.


RESULTS
The cardiopulmonary bypass and cross-clamp times were significantly higher in the superior septal group. No significant difference in blood loss was found between the two groups, and no residual atrial septal defect was found in patients in whom we used the superior septal approach. The maintainance of sinus rhythm at late follow-up and the incidences of postoperative arrhythmias and newly developed atrioventricular block were not significantly different between the two groups.


CONCLUSIONS
The use of the superior septal approach to the mitral valve is not associated with a greater incidence of rhythm disturbances or other complications. Because this approach provides optimal exposure of the valve and the subvalvular apparatus, it has been routinely adopted for use in patients undergoing mitral valve replacement at our institution.
Gaudino
M
M
Department of Cardiac Surgery, Catholic University, Rome, Italy.
Alessandrini
F
F
Glieca
F
F
Martinelli
L
L
Santarelli
P
P
Bruno
P
P
Possati
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002315:Cardiopulmonary Bypass / Q000379:methods; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D006346:Heart Septum / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000601:surgery; D011446:Prospective Studies; D012086:Reoperation