Key result
The superior transseptal approach in mitral valve surgery resulted in a higher rate of temporary pacing (49.2%) compared to transseptal (30.5%) and left atriotomy (25.5%) approaches (p=0.013).
Why the study?
The study investigated how atriotomy approaches in mitral valve surgery and sinoatrial nodal artery variations affect postoperative arrhythmias and pacemaker requirements.
Does the choice of atriotomy approach affect postoperative arrhythmias and pacemaker need in patients undergoing isolated mitral valve surgery?
Cohort (n=241)
Does the choice of atriotomy approach affect postoperative arrhythmias and pacemaker need in patients undergoing isolated mitral valve surgery?
The superior transseptal approach in isolated mitral valve surgery is associated with a higher need for temporary pacing compared to left atriotomy and transseptal approaches, though it does not increase the need for permanent pacemakers.
May warrant caution selecting superior transseptal approach; leaves open effects on permanent pacing and optimal atriotomy choice.
Background: This study aims to investigate the effect of atriotomy approaches applied in mitral valve surgery and variations of the sinoatrial nodal artery on postoperative arrhythmias and the need for a temporary or permanent pacemaker. Methods: Data of 241 patients (108 males, 133 females, mean age: 53.7±12.3 years; range, 18 to 82 years) who underwent isolated mitral valve surgery with a median sternotomy between January 2009 and December 2019 were retrospectively analyzed. The patients were divided into three groups according to the surgical approach for mitral valve exploration as left atriotomy (n=47), transseptal (n=131), and superior transseptal (n=63). By scanning the hospital records, the origin of the sinoatrial nodal artery was determined in the coronary angiography images obtained before surgery. Postoperative rhythm changes were analyzed based on electrocardiography and telemetry recordings. Results: Temporary pacing was required in 31 (49.2%) patients in the superior transseptal group, 40 (30.5%) patients in the transseptal group, and 12 (25.5%) patients in the left atriotomy group, indicating a statistically significantly higher rate in the superior transseptal group (p=0.013). Permanent pacemaker implantation was required in only one patient (superior transseptal), indicating no significant difference among the groups. The first-degree atrioventricular block was seen in 28 (44.4%) patients in the superior transseptal group, 42 (32.1%) patients in the transseptal group, and 13 (27.7%) patients in the left atriotomy group (p=0.130). The PR interval in the postoperative period was longer in the superior transseptal group than in the left atriotomy group in patients with the sinoatrial nodal artery originating from the right coronary artery (p=0.049). No significant difference was observed among the surgical approaches regarding the PR interval in patients with the sinoatrial nodal artery originating from the left circumflex coronary artery after surgery. Conclusion: We believe that the choice of atriotomy in isolated mitral valve surgery and sinoatrial nodal artery variations do not affect permanent arrhythmia alone. Still, the superior transseptal approach causes the electrical conduction to slow down temporarily more than the left atriotomy and transseptal method.
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Reyhancan et al. (2022) conducted a cohort in Isolated mitral valve surgery (n=241). Superior transseptal approach vs. Transseptal and left atriotomy approaches was evaluated on Need for temporary pacing (p=0.013). The superior transseptal approach in mitral valve surgery resulted in a higher rate of temporary pacing (49.2%) compared to transseptal (30.5%) and left atriotomy (25.5%) approaches (p=0.013).
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