Improved Combined Superior-Transseptal Approach to the Mitral Valve

Abstract

In mitral valve surgery, the combined superior-transseptal approach gives excellent exposure of the mitral valve, but it is lengthy and complex. A modified version of this approach was made without cutting the right atrial appendage and the dome of the right atrium. This shorter procedure was evaluated in 30 patients aged 4–61 years undergoing complex mitral valve operations including mitral repair (33.3%), reoperation (30%), and small left atrium (30%). The mitral valve was exposed well in all cases. Because of the shorter incision, closure was relatively easy. The aortic crossclamp time was 117 ± 29.9 min (range, 53-173). There were no major complications. Cardiac rhythm resumed spontaneously after release of the aortic clamp in 93.3% of patients, including 36.7% who regained sinus rhythm from arrhythmia preoperatively. There was no heart block, bleeding, or mortality. Results at 3 months were good. Despite a decreased operative field, this modified approach provided adequate exposure for all the required techniques. The benefits of this approach are a shorter incision in the atrial muscle, and simplified closure technique.