Transseptal Approach for Mitral Valve Replacement

Background Although the access to the mitral valve through transseptal approach is technically more demanding, it allows a better exposure of its leaflets and subvalvular apparatus, specially, in small atria, in reoperations or when it is combined with tricuspid valve treatment.ObjectiveTo evaluate technical difficulties and complications associated with the transseptal approach for mitral valve replacement.Material and MethodsBetween 2006 and 2009, 62 consecutive patients who underwent mitral valve replacement alone or associated with myocardial revascularization through a transseptal approach extended to the left atrial roof were included. Technical difficulties and morbimortality of the procedure were evaluated.ResultsIn all patients, the transseptal approach could be done with no technical difficulties with an appropriate exposure of the mitral valve. The rate of conduction disorders in the postoperative period was 9.7% and the need of a permanent pacemaker implantation was 4.8%. From patients who had previous atrial fibrillation (n = 18), 83.3% recovered high sinus or junctional rhythm during the postoperative period.ConclusionsThe transseptal approach extended to the left atrial roof constituted an access alternative to the mitral valve, with an exposure better than the traditional approach, at the expense of a more demanding technique. Surgical times, mortality and complications were similar to those which belong to the conventional technique, except for a probable greater incidence of junctional rhythm and AV block. Possibly, there is certain benefit in the recovery of sinus rhythm in patients with previous chronic atrial fibrillation.REV ARGENT CARDIOL 2010;78:400-404.