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Subject Area

Surgery

Article Type

Original Study

Abstract

Objectives: This study evaluates safety and effectiveness of the vertical trans-septal approach as compared to standard left atriotomy for mitral valve surgery regarding intraoperative and early post-operative results. Background: Perfect exposure of the mitral valve (MV) is crucial to perform any type of MV surgery. Small left atrium (LA) and very deep thoracic cavity are factors affecting the MV visualization. Sometimes, the conventional (LA) incision through Sondergaard’s groove does not give ideal exposure. Recently the vertical transseptal approach (VTSA) has become popular because it offers excellent exposure of the (MV) and it is easy to close. Methods: one hundred patients indicated for mitral valve surgery divided into two groups. Group A underwent surgery through standard left atriotomy while Group B underwent it through vertical trans-septal approach. They were followed up for up to one year with electrocardiogram and transthoracic echocardiography to assess development of arrhythmia and mitral valve condition. Results: Intraoperative results showed that Aortic Cross Clamp (ACC) mean time in group A was 47.88±13.16 minutes while in group B the (ACC) mean time was 50.54±13.89 showing no statistical difference. The study showed that the postoperative atrial fibrillation and heart block showed no statically significant difference between both groups. Conclusion: We proved that vertical transseptal approach seems to be similarly effective and safe as conventional approach. The vertical transseptal approach is a valuable approach especially in patients with a small LA, combined tricuspid and mitral valve operations and redo mitral valve surgeries.

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