Effectiveness and safety of superior septal approach for complex mitral valve surgery

Hu Haiou; Zhu Junming; Liu Wei; Chen Lei; Cheng Lijian; Sun Lizhong

doi:10.3760/cma.j.issn.1673-4777.2017.07.008

Abstract：Objective To explore the effectiveness and safety of complex mitral valve surgery via superior septal approach.Methods Totally 86 adult patients who had mitral valve surgery from August 2011 to November 2014 in Beijing Anzhen Hospital,Capital Medical University were retrospectively analyzed;43 patients were operated via superior septal approach (SSA group);43 patients had interatrial septal approach (ISA group).Operation data,operative effects and complications were analyzed.Results All patients were successfully operated;no re-cardiopulmonary bypass(CPB) was required.The SSA group had concomitant operations including aortic valve replacement(n =15),tricuspid valve plasty (n =10),coronary artery bypass grafting (n =5) and Bentall operation(n =1);the ISA group had aortic valve replacement(n =15),tricuspid valve plasty(n =19),coronary artery bypass grafting (n =3) and Bentall operation (n =1).The operation time,CPB time,aortic cross-clamp time in SSA and ISA group were (266 ± 67) min vs (243 ± 63) min,(135 ± 46) min vs (110 ± 34)min,(101 ±38)min vs (76 ± 29)min,respectively;there were no significant differences between groups (P ＞ 0.05).The SSA group had 25 cases of sinus rhythm(SR) before operation;4 cases had nodal rhythm after operation,among them 3 cases were applied temporary pacemaker;6 in 17 cases of preoperative atrial fibrillation (AF) regained SR.In ISA group,4 in 13 patients with preoperative SR had AF;10 in 29 patients with preoperative AF regained SR.Postoperative 24 h drainage volume and 24 h incidence of complications had no significant differences between groups(P ＞ 0.05).Conclusion Mitral valve surgery via superior septal approach is feasible and effective;it provides better operative field and eusures the safety of operation.