Key result
Transseptal (n=13) and transatrial (n=24) approaches for redo-mitral valve replacement yielded comparable short-term outcomes, with an overall cohort mortality of 10.8%.
Why the study?
Redo cardiac surgeries and associated complications are increasing, but how the surgical approach affects overall outcome has not been well addressed in the literature.
Does the trans-atrial approach compared to the trans-septal approach improve short-term outcomes in patients undergoing redo-mitral valve replacement?
Observational (n=37)
No
Does the trans-atrial approach compared to the trans-septal approach improve short-term outcomes in patients undergoing redo-mitral valve replacement?
Transatrial and transseptal approaches for redo-mitral valve replacement yield comparable short-term outcomes.
Background: Cardiac surgery has become more common and crucial nowadays. The matter which leads to increased redo-surgeries with expected increase of overall complications after the redo. The used approach could affect overall outcome. However, this is not addressed well in literature.Aim of the work: To examine the overall outcome of patients underwent redo-mitral valve replacement [redo-MVR].Patients and methods: This study is a retrospective comparative study that was conducted in Cardiothoracic Surgery Department, Al-Hussein University Hospital in the last three years [from January, 1st, 2017 to the end of December 2019]. Collected data included patient demographics, surgical approach and overall short-term outcome.Results: The current study included 37 patients; the mean age was 45.19±9.16 years. The most common indication for redo was pannus formation [48.6%], followed by thrombosis [45.9%]. There was no significant difference between preoperative and postoperative heart rhythm. Redo sternotomy was the most common, reported in all patients, and femoral bypass done for 3 patients. Trans-atrial approach reported in 24 patients [64.86%] while Trans-septal approach reported in 13 patients [35.14%]. No significant difference between preoperative and postoperative echo data [Ejection Friction, left atrial dimension or left ventricle end diastolic dimension]. However, there was a significant reduction of left ventricle end-systolic dimension [LVESD], pulmonary artery systolic pressure [PASP] and pressure gradient [PG] cross mitral valve after operation. Reoperation for bleeding was not reported in any cases, while need for new pacemaker reported in 2 patients [5.41%], new postoperative neurological dysfunction reported in new heart failure or need to dialysis in two patients [5.41%]. The postoperative arrhythmia was reported in 7 patients [18.9%] and there has been mortality in three patients [10.8%].Conclusion: The results of the current study showed that, both transseptal and transatrial approaches are comparable and no one is superior to the other.
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Hassan et al. (2021) conducted an observational in Redo-mitral valve replacement (n=37). Transseptal approach vs. Transatrial approach was evaluated on Overall short-term outcome. Transseptal (n=13) and transatrial (n=24) approaches for redo-mitral valve replacement yielded comparable short-term outcomes, with an overall cohort mortality of 10.8%.
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