title: Superior septal approach versus left atrial approach for mitral valve replacement: A retrospective cohort study.
abstract: OBJECTIVE
  To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement.
  
  
  METHODS
  This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (<30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis.
  
  
  RESULTS
  Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for baseline variables except cardiopulmonary bypass and cross-clamp times, which were significantly shorter in the superior septal approach group than the left septal approach group (p<0.05). No residual atrial septal defect was found in any approach. Although loss of normal sinus rhythm was observed more frequent in superior septal approach 25(48%) compared to left septal approach 10(38.4%), but the difference was statistically insignificant (p=0.28). Age was the only significant variable affecting loss of normal sinus rhythm after adjusting for approaches. The difference of post-operative complications was also statistically insignificant between superior 9(17.3%) and left septal approach 4(15.38%) (p=1.0)].
  
  
  CONCLUSIONS
  The operative durations were significantly higher in left atrial approach compared to superior septal approach.
authors.affiliation: Medical Student, The Aga Khan University Hospital, Karachi.
authors.forename: Tooba
authors.initials: T
authors.lastname: Ansar
authors.affiliation: Department of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Taimur Asif
authors.initials: TA
authors.lastname: Ali
authors.affiliation: The Aga Khan University Hospital, Karachi.
authors.forename: Saneeha
authors.initials: S
authors.lastname: Shahid
authors.affiliation: Department of Cardiothoracic Surgery, The Aga Khan University Hospital, Karachi.
authors.forename: Saulat Hasnain
authors.initials: SH
authors.lastname: Fatimi
authors.affiliation: Department of General Surgery, Patel Hospital, Karachi.
authors.forename: Ghulam
authors.initials: G
authors.lastname: Murtaza
mesh_terms: D000328:Adult; D005260:Female; D006325:Heart Atria / Q000601:surgery*; D006346:Heart Septum / Q000601:surgery*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000453:epidemiology / Q000601:surgery*; D010154:Pakistan / Q000453:epidemiology; D012189:Retrospective Studies
keywords:  Superior septal approach, Left atrial approach, Mitral valve replacement, Arrhythmia, Mortality. 