Mitral valve surgery: comparison between superior septal and left atrial approaches
Background Mitral valve (MV) is one of the most complex structures in human heart with a challenging exposure. Traditionally, MV is approached via left atriotomy (LAA) while superior septal approach (SSA) is an alternative. Objective: is to highlight the merits and demerits of these two approaches...
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| Format: | Article |
| Language: | English |
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College of Medicine University of Baghdad
2021-02-01
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| Series: | مجلة كلية الطب |
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| Online Access: | https://iqjmc.uobaghdad.edu.iq/index.php/19JFacMedBaghdad36/article/view/1810 |
| _version_ | 1797368512721715200 |
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| author | Abdulsalam Yaseen Taha Shkar Raouf Haji Saed Amanj Kamal Mohammed Jivara Hama Nadr |
| author_facet | Abdulsalam Yaseen Taha Shkar Raouf Haji Saed Amanj Kamal Mohammed Jivara Hama Nadr |
| author_sort | Abdulsalam Yaseen Taha |
| collection | DOAJ |
| description | Background Mitral valve (MV) is one of the most complex structures in human heart with a challenging exposure. Traditionally, MV is approached via left atriotomy (LAA) while superior septal approach (SSA) is an alternative.
Objective: is to highlight the merits and demerits of these two approaches in providing access to the MV in term of the aortic cross clamp time (ACCT), quality of exposure, and potential complications in view of the published literature.
Patients and Method: Over an 18-month period ending at June 30th, 2019, 56 patients with MV disease ± other cardiac diseases were enrolled in this study. Twenty patients had surgery via LAA (one surgeon) whereas 36 were operated upon via SSA (another surgeon). Standard surgery was done via median sternotomy, cardiopulmonary bypass and hypothermia of 32 0C. Perioperative events were recorded.
Results In SSA group (males=25; age ranged 23-74 years; mean=57.4), patients had chest pain and breathlessness for a mean of 3 months (>LAA) besides low ejection fraction (EF) in 44%, atrial fibrillation (AF) in 38.9% and dilated LA in 19.4%. They underwent 25 MV replacements (MVR), 11 MV repairs (0 in LAA), 11 coronary artery bypass grafts (CABGs) (2.6 graft per patient vs. 1.3 in LAA; significant) and 2 aortic valve replacement. Mean ACCT was 81.6 minutes (˂LAA). Postoperatively, 32 patients (88.9%) had a normal or improved EF, 11 of 14 AF patients (78.6%) reverted to sinus rhythm and no hospital death was recorded. Conclusion Besides excellent exposure, the SSA enabled us to perform MVR or repair ± additional interventions within a short time and without a heart block. Hence, our results matched the international literature. |
| first_indexed | 2024-03-08T17:33:33Z |
| format | Article |
| id | doaj.art-46709fdb7a5e4595b0d989c694b10a07 |
| institution | Directory Open Access Journal |
| issn | 0041-9419 2410-8057 |
| language | English |
| last_indexed | 2024-03-08T17:33:33Z |
| publishDate | 2021-02-01 |
| publisher | College of Medicine University of Baghdad |
| record_format | Article |
| series | مجلة كلية الطب |
| spelling | doaj.art-46709fdb7a5e4595b0d989c694b10a072024-01-02T13:45:31ZengCollege of Medicine University of Baghdadمجلة كلية الطب0041-94192410-80572021-02-0162410.32007/jfacmedbagdad.6241810Mitral valve surgery: comparison between superior septal and left atrial approachesAbdulsalam Yaseen Taha0Shkar Raouf Haji Saed1Amanj Kamal MohammedJivara Hama NadrUniversity of Sulaimani College of MedicineUniversity of Sulaimani College of MedicineBackground Mitral valve (MV) is one of the most complex structures in human heart with a challenging exposure. Traditionally, MV is approached via left atriotomy (LAA) while superior septal approach (SSA) is an alternative. Objective: is to highlight the merits and demerits of these two approaches in providing access to the MV in term of the aortic cross clamp time (ACCT), quality of exposure, and potential complications in view of the published literature. Patients and Method: Over an 18-month period ending at June 30th, 2019, 56 patients with MV disease ± other cardiac diseases were enrolled in this study. Twenty patients had surgery via LAA (one surgeon) whereas 36 were operated upon via SSA (another surgeon). Standard surgery was done via median sternotomy, cardiopulmonary bypass and hypothermia of 32 0C. Perioperative events were recorded. Results In SSA group (males=25; age ranged 23-74 years; mean=57.4), patients had chest pain and breathlessness for a mean of 3 months (>LAA) besides low ejection fraction (EF) in 44%, atrial fibrillation (AF) in 38.9% and dilated LA in 19.4%. They underwent 25 MV replacements (MVR), 11 MV repairs (0 in LAA), 11 coronary artery bypass grafts (CABGs) (2.6 graft per patient vs. 1.3 in LAA; significant) and 2 aortic valve replacement. Mean ACCT was 81.6 minutes (˂LAA). Postoperatively, 32 patients (88.9%) had a normal or improved EF, 11 of 14 AF patients (78.6%) reverted to sinus rhythm and no hospital death was recorded. Conclusion Besides excellent exposure, the SSA enabled us to perform MVR or repair ± additional interventions within a short time and without a heart block. Hence, our results matched the international literature.https://iqjmc.uobaghdad.edu.iq/index.php/19JFacMedBaghdad36/article/view/1810Left atrium, mitral valve exposure, left atrial approach, superior septal approach. |
| spellingShingle | Abdulsalam Yaseen Taha Shkar Raouf Haji Saed Amanj Kamal Mohammed Jivara Hama Nadr Mitral valve surgery: comparison between superior septal and left atrial approaches مجلة كلية الطب Left atrium, mitral valve exposure, left atrial approach, superior septal approach. |
| title | Mitral valve surgery: comparison between superior septal and left atrial approaches |
| title_full | Mitral valve surgery: comparison between superior septal and left atrial approaches |
| title_fullStr | Mitral valve surgery: comparison between superior septal and left atrial approaches |
| title_full_unstemmed | Mitral valve surgery: comparison between superior septal and left atrial approaches |
| title_short | Mitral valve surgery: comparison between superior septal and left atrial approaches |
| title_sort | mitral valve surgery comparison between superior septal and left atrial approaches |
| topic | Left atrium, mitral valve exposure, left atrial approach, superior septal approach. |
| url | https://iqjmc.uobaghdad.edu.iq/index.php/19JFacMedBaghdad36/article/view/1810 |
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