August 14, 2026Asian Cardiovascular and Thoracic Annals
Transseptal versus left atrial approach for mitral valve surgery: A systematic review and meta-analysis
Key result
Transseptal mitral surgery is linked to ~44% higher PPM risk versus left atrial approach.
- RR 1.44
- 95% CI 1.07-1.95
- P=0.01
Why the study?
The optimal surgical access for mitral valve surgery remains debated, as studies report differing perioperative and postoperative outcomes between transseptal and left atrial approaches.
Does the transseptal approach increase the risk of permanent pacemaker implantation compared to the left atrial approach in patients undergoing mitral valve surgery?
Comparison
Transseptal approach vs left atrial approach
Design
Systematic review and meta-analysis
Authors
Discussion
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Implication
TS approach linked to longer operative times and higher pacemaker risk than LA in MVS; extends pooled evidence favoring LA to minimize complications.
Key Points
- To systematically evaluate and compare the perioperative and postoperative clinical outcomes between transseptal and left atrial approaches in mitral valve surgery.
- Conducted a systematic review and meta-analysis across PubMed, Embase, and Scopus databases through June 2025 adhering to PRISMA guidelines.
- Included 25 studies comparing transseptal versus left atrial approaches, analyzing permanent pacemaker implantation as the primary outcome alongside other surgical metrics.
- The transseptal approach was associated with a significantly higher risk of permanent pacemaker implantation (RR: 1.44, 95% CI [1.07–1.95]; P = 0.01).
- Transseptal access was linked to higher rates of postoperative atrial fibrillation, junctional rhythm, atrioventricular block, temporary pacing, increased bleeding, and longer cardiopulmonary bypass and aortic cross-clamp times.
- No significant differences were identified between approaches regarding mortality, intensive care unit stay, stroke, infection, or renal failure.
Study Design
Type
Meta-Analysis
Structured PICO
Does the transseptal approach increase the risk of permanent pacemaker implantation compared to the left atrial approach in patients undergoing mitral valve surgery?
P
Population
Meta-analysis of 25 studies comparing transseptal versus left atrial approaches for mitral valve surgery.
I
Intervention
Transseptal (TS) approach
C
Comparator
Left atrial (LA) approach
O
Outcome
Permanent pacemaker (PPM) implantationhard clinical
Main Result
Relative Risk: 1.44 (95% CI 1.07–1.95)
p-value: p=0.01
The transseptal approach for mitral valve surgery is associated with longer operative times and a significantly higher risk of postoperative conduction disturbances and permanent pacemaker implantation compared to the left atrial approach.
Cite This Study
Paramkusam et al. (2026) conducted a meta-analysis in Mitral valve surgery. Transseptal (TS) approach vs. Left atrial (LA) approach was evaluated on Permanent pacemaker (PPM) implantation (RR 1.44, 95% CI 1.07-1.95, p=0.01). The transseptal approach for mitral valve surgery was associated with a higher risk of permanent pacemaker implantation compared to the left atrial approach (RR 1.44; 95% CI 1.07-1.95; P=0.01).