Key result
The transseptal approach (n=15) was equally effective compared to the transatrial approach (n=15) for redo mitral valve replacement, with no significant differences in outcomes.
Why the study?
Previous cardiac operations complicate mitral valve exposure, where conventional left atrial incisions may not offer satisfactory visualization, prompting alternative approaches.
Does the transseptal approach improve intraoperative or postoperative outcomes compared to the transatrial approach in patients undergoing redo mitral valve surgery?
Cohort (n=30)
Yes
Does the transseptal approach improve intraoperative or postoperative outcomes compared to the transatrial approach in patients undergoing redo mitral valve surgery?
The transseptal approach appears to be equally effective to the transatrial approach for mitral valve replacement in redo patients.
Comparable outcomes in small redo cohort support transseptal equivalence to transatrial; leaves open need for larger prospective trials.
Background: Previous cardiac operations may complicate mitral valve exposure, as adhesions and loss of mobility in the surrounding tissues may be present. In such cases, the conventional left atrial (LA) incision may not offer satisfactory visualization in the surgical site of the valve. Therefore, several alternative approaches have been proposed for satisfactory visualization of the mitral valve intraoperatively.Aim of the work: to evaluate the outcome of the transseptal and transatrial approaches for mitral valve replacement in patients undergoing redo mitral valve surgery.Patients and Method: This is a prospective study that was conducted at Cardio-thoracic surgery department of Al-Azhar University hospital (Damietta) and other centers during the period from the January 2018 to May 2019. It included 30 patients undergoing redo mitral valve surgery; 15 of them had transseptal approach and 15 with transatrial approach.Results: Age was comparable between studied groups. There was 6 males (40.0%) in group I and 7 males (46.7%) in group II. Smoking was reported in 8 (53.3%) in group I and 7 (46.7%) in group II. Hypertension and pulmonary disease were reported in 6 (40.0%) versus 7 (46.7%) and 2 (13.3%) versus 3 (20.0%) in groups I and II respectively. Diabetes mellitus was reported in 9 (60.0%) in group I versus 4 (26.7%) in group II. Finally, there was no significant difference between both approaches as regard to intraoperative or postoperative data. Conclusion: Transatrial approach has been used in most of previous studies; the transseptal approach appears to be equally effective.
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Hitawy et al. (2020) conducted a cohort in Redo mitral valve surgery (n=30). Transseptal approach vs. Transatrial approach was evaluated on Intraoperative and postoperative outcomes. The transseptal approach (n=15) was equally effective compared to the transatrial approach (n=15) for redo mitral valve replacement, with no significant differences in outcomes.
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