Comparison between inter atrial and trans-septal approach in mitral valve surgery

Haitham Akram Altaani, Safwan Alfawares, Saker Asharoo, Mahmoud Obeidat, Khaled Maloof


Background: Two traditional approaches performed in mitral valve surgery, no solid indication for either technique.

Our aim of this study is to compare the indications, and the outcome of these two techniques.

Methods: In this retrospective study we analysed the data of 148 patients who underwent mitral valve procedure from January 2013 till the end of December 2013 using the medical records. The procedures done either isolated mitral valve surgery (42%) or as a concomitant with other procedures (58%), total number of males were 58 cases (39%), and the average age was 54±8 years. We divided the patients into two groups; group one for those who underwent the procedure using direct left atrial approach by doing incision through the intertribal groove, and group two for those who underwent the procedure through inter atrial septum after opening of the right atrium (trans-septal), total number of group one was 78 (53%), while for group two the number was 70 (47%). Preoperative, intraoperative and post-operative variables were analysed and compared.

Results: Total mortality was 6 patients (4%), 4 of the in group one and 2 in group two, bleeding more than 750 ml post operatively was seen in 38 patients (26%), 15 (39%), 23 (61%) in group one and two respectively. Reopening for bleeding performed for 11 cases (7%), 2 of the in group one (18%) and 9 in group two (82%). Postoperative atrial fibrillation and heart block was more in group two.

Conclusions: Mitral valve surgery can be done traditionally using two different approaches, no solid indications for either technique. The decision to choose either approach should be taken preoperatively.


Mitral valve, Atrial septum, Atrial fibrillation

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