Comparison of safety and outcomes with two approaches to the mitral valve.
Adult
Cardiac Surgical Procedures
/ methods
Cardiopulmonary Bypass
Constriction
Heart Atria
/ surgery
Heart Septum
/ surgery
Heart Valve Diseases
/ surgery
Humans
Incidence
Male
Middle Aged
Mitral Valve
/ surgery
Operative Time
Postoperative Complications
/ epidemiology
Retrospective Studies
Sick Sinus Syndrome
/ epidemiology
Treatment Outcome
Young Adult
clinical review
valve repair/replacement
Journal
Journal of cardiac surgery
ISSN: 1540-8191
Titre abrégé: J Card Surg
Pays: United States
ID NLM: 8908809
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
23
03
2020
revised:
23
04
2020
accepted:
24
04
2020
pubmed:
5
5
2020
medline:
3
11
2020
entrez:
5
5
2020
Statut:
ppublish
Résumé
The efficacy of the superior trans-septal (STS) approach to the mitral valve has been offset by the perceived risks of adverse postoperative events. The aim of this study was to review our experience with using the left atriotomy (LA) and STS approaches in patients undergoing mitral valve surgery. Charts of patients who underwent mitral valve surgery by a single surgeon over a period of 20 years were reviewed retrospectively. A total of 319 patients (aged 42.9 ± 16.2 years) were studied. Surgical operations were carried out through the LA approach in 111 patients, and through the STS approach in 208 patients. The two groups were comparable in terms of patients' characteristics, but cardiopulmonary bypass and aortic cross-clamp times were longer in the STS approach group (P = .0005). No technical complications related to either approach occurred. Rates of re-exploration for postoperative bleeding, durations of intensive care unit (ICU) stay, in-hospital days, and mortality were comparable in both approaches. Statistical analyses indicated that a patient was more likely to maintain a preoperative sinus rhythm if the LA approach rather than the STS approach was used (P < .05). On the other hand, when the preoperative heart rhythm was atrial fibrillation, no significant difference in perioperative changes in heart rhythm was observed between the two approaches. This study confirms that the routine use of the STS approach is not associated with important adverse postoperative outcomes, but is associated with increased incidence of postoperative sinus node dysfunction in patients who were in sinus rhythm preoperatively.
Sections du résumé
BACKGROUND AND AIM
OBJECTIVE
The efficacy of the superior trans-septal (STS) approach to the mitral valve has been offset by the perceived risks of adverse postoperative events. The aim of this study was to review our experience with using the left atriotomy (LA) and STS approaches in patients undergoing mitral valve surgery.
METHODS
METHODS
Charts of patients who underwent mitral valve surgery by a single surgeon over a period of 20 years were reviewed retrospectively. A total of 319 patients (aged 42.9 ± 16.2 years) were studied. Surgical operations were carried out through the LA approach in 111 patients, and through the STS approach in 208 patients.
RESULTS
RESULTS
The two groups were comparable in terms of patients' characteristics, but cardiopulmonary bypass and aortic cross-clamp times were longer in the STS approach group (P = .0005). No technical complications related to either approach occurred. Rates of re-exploration for postoperative bleeding, durations of intensive care unit (ICU) stay, in-hospital days, and mortality were comparable in both approaches. Statistical analyses indicated that a patient was more likely to maintain a preoperative sinus rhythm if the LA approach rather than the STS approach was used (P < .05). On the other hand, when the preoperative heart rhythm was atrial fibrillation, no significant difference in perioperative changes in heart rhythm was observed between the two approaches.
CONCLUSIONS
CONCLUSIONS
This study confirms that the routine use of the STS approach is not associated with important adverse postoperative outcomes, but is associated with increased incidence of postoperative sinus node dysfunction in patients who were in sinus rhythm preoperatively.
Types de publication
Comparative Study
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1458-1463Informations de copyright
© 2020 Wiley Periodicals, Inc.
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