title: Superior left atrial approach to the mitral valve: incidence of postoperative arrhythmia.
abstract: OBJECTIVE
  The superior left atrial approach to mitral surgery involves exposure of the mitral valve through a longitudinal, craniocaudally orientated incision in the roof of the left atrium. The study aim was to evaluate the incidence of postoperative arrhythmias following this procedure.
  
  
  METHODS
  Fifty-nine patients underwent either mitral valve repair (n = 20), mitral valve replacement (n = 26) or an associated procedure (n = 13), including aortic valve replacement, coronary artery bypass grafting and atrial septal defect closure. Eight patients had undergone previous surgery on the mitral valve. Patients were classified according to their preoperative rhythm: sinus rhythm (SR), paroxysmal or chronic atrial fibrillation (AF), or permanent pacing. Changes in cardiac rhythm were evaluated postoperatively, after four weeks, and at late follow up (mean 23.8 months).
  
  
  RESULTS
  Preoperatively, 24 patients had shown SR, 10 had paroxysmal AF, 24 had chronic AF, and one patient had permanent pacing. At the time of discharge, SR was recorded in 18 patients who had SR preoperatively, in seven who had paroxysmal AF preoperatively, and in one patient who had chronic AF preoperatively. At follow up, SR was seen in 19 patients with preoperative SR, in seven with paroxysmal AF preoperatively, and in two with chronic AF preoperatively. Four patients received permanent pacemakers postoperatively due to total heart block or bradycardia.
  
  
  CONCLUSIONS
  The superior left atrial approach to mitral valve surgery appears to be safe as it maintains the sinus rhythm in a high proportion of patients postoperatively. In addition, it is not normally prone to technical complications.
authors.affiliation: Department of Cardiac Surgery, Medical University of Graz, Austria. peter.bergmann@kfunigraz.ac.at
authors.forename: Peter
authors.initials: P
authors.lastname: Bergmann
authors.forename: Stefan
authors.initials: S
authors.lastname: Huber
authors.forename: Ronald
authors.initials: R
authors.lastname: Hödl
authors.forename: Heinrich
authors.initials: H
authors.lastname: Mächler
authors.forename: Peter
authors.initials: P
authors.lastname: Oberwalder
authors.forename: Daniela
authors.initials: D
authors.lastname: Martin
authors.forename: Bruno
authors.initials: B
authors.lastname: Rigler
mesh_terms: D000368:Aged; D001146:Arrhythmia, Sinus / Q000517:prevention & control*; D001281:Atrial Fibrillation / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D002908:Chronic Disease; D004452:Echocardiography; D015716:Electrocardiography, Ambulatory; D005260:Female; D006350:Heart Valve Prosthesis; D006801:Humans; D015994:Incidence; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D008946:Mitral Valve Stenosis / Q000601:surgery*; D010138:Pacemaker, Artificial; D012189:Retrospective Studies