COMPARATIVE STUDY ON TRANSSEPTAL APPROACH VS TRANS LEFT ATRIAL APPROACH FOR MITRAL VALVE PROCEDURE.
Main Article Content
Keywords
Mitral valve complex, LA approach, TS approach
Abstract
Objective: This study aims to compare the two approaches of mitral valve exposure in isolated mitral valve disease for their intra-operative and post-operative outcomes.
Material and Methods: All patients who underwent isolated mitral valve surgery from May 2022 to March 2023 were enrolled in the study, after they met the inclusion and exclusion criteria. Patients include only mitral valve disease. Patient with severe LV dysfunctions and patient with bleeding tendency were excluded. We had taken into account are operating time, post op bleeding and arrythmia.
Results: After analysing total pump time, total aortic cross clamp time, post operative bleeding and arrythmia in both the group, there was no significantdifferences in outcome in any of the methods.
Conclusion: The LA approach is the most used approach which provides satisfactory exposure of the mitral valve and the sub valvar apparatus. However, patient characteristics and circumstances limit the versatility of this approach.The TS approach provides optimal exposure of the mitral valve complex even in the presence of inexperience assistant surgeons or trainee surgeons or hostile anatomical conditions or redo surgeries. Studies have associated the transseptal approach with multiple complications of excessive bleeding, post operative rhythm disturbances and subsequent need for pacemaker implantation. After comparison of multiple intra-operative and post-operative variables, we found that the TS approach is a valuable approach to the mitral valve providing excellent visibility even in hostile anatomy or operative conditions delivering comparable results to the conventional LA approach.
References
2. Kumar RK, Tandon R. Rheumatic fever & rheumatic heart disease: the last 50 years. Indian Journal of Medical Research. 2013; 137(4):643-58.
3. Negi PC, Sondhi S, Asotra S, Mahajan K, Mehta A. Current status of rheumatic heart disease in India. Indian Heart Journal. 2019; 71(1):85-90
4. Padmavati S. Rheumatic fever and rheumatic heart disease in India at the turn of the century. Indian Heart Journal. 2001; 53(1):35-7.
5. Bhaya M, Panwar S, Beniwal R, Panwar RB. High prevalence of rheumatic heart disease detected by echocardiography in school children. Echocardiography. 2010; 27(4):448-53.
6. Iung B, Baron G, Tornos P, Gohlke-Bärwolf C, Butchart EG, Vahanian A,. Valvular heart disease in the community: a European experience. Current Problems in Cardiology. 2007; 32(11):609-61.
7. Cohn LH. The first successful surgical treatment of mitral stenosis: the 70th anniversary of Elliot Cutler's mitral commissurotomy. Annals of Thoracic Surgery. 1993; 56(5):1187-90.
8. Cherian G, Vytilingam KI, Sukumar IP, Gopinath N. Mitral Valvotomy in Young Patients. British Heart Journal. 1964; 26(2):157-66.
9. Cheung A, Webb JG, Wong DR, Ye J, Masson JB, Carere RG, Lichtenstein SV. Transapical transcatheter mitral valve-in-valve implantation in a human. Annals of Thoracic Surgery. 2009; 87(3):e18-20.
10. Seeburger J, Rinaldi M, Nielsen SL, Salizzoni S, Lange R, Schoenburg M, Alfieri O, Borger MA, Mohr FW, Aidietis A,. Off-pump transapical implantation of artificial neo-chordae to correct mitral regurgitation: the TACT Trial (Transapical Artificial Chordae Tendinae) proof of concept. Journal of the American College of Cardiology. 2013; 63(9):914-9.
11. Choudhary SK, Talwar S, Dubey B, Chopra A, Saxena A, Kumar AS. Mitral valve repair in a predominantly rheumatic population. Long-term results. Texas Heart Institute Journal. 2001; 28(1):8-15.
12. Utley JR, Leyland SA, Nguyenduy T. Comparison of outcomes with three atrial incisions for mitral valve operations. Right lateral, superior septal, and transseptal. The Journal of Thoracic and Cardiovascular Surgery. 1995; 109(3):582-7.
13. Tambeur L, Meyns B, Flameng W, Daenen W. Rhythm disturbances after mitral valve surgery: comparison between left atrial and extended trans-septal approach. Cardiovascular surgery. 1996; 4(6):820-4.
14. Kumar N, Saad E, Prabhakar G, De Vol E, Duran CM. Extended transseptal versus conventional left atriotomy: early postoperative study. Annals of Thoracic Surgery. 1995; 60(2):426-30.
15. Ananthanarayanan C, Malhotra A, Siddiqui S, Shah P, Pandya H, Sharma P, Shukla A, Thosani R. Repairing the rheumatic mitral valve in the young: The horizon revisited. The Journal of Thoracic and Cardiovascular Surgery OpenThe Journal of Thoracic and Cardiovascular Surgery Open. 2020; 1:20-28.
16. Mujtaba SS, Clark SC. Extended trans-septal versus left atrial approach in mitral valve surgery: 1017 patients' experience. Heart Asia. 2018; 10(2):e011008.
17. Harky A, Kusu-Orkar TE, Chan JSK, Noshirwani A, Savarimuthu S, Pousios D, Muir AD. Left Atrial or Transeptal Approach for Mitral Valve Surgery: A Systematic Review and Meta-analysis. Current Problems in Cardiology. 2021; 46(3):100602.
18. Masiello P, Triumbari F, Leone R, Itri F, Del Negro G, Di Benedetto G. Extended vertical transseptal approach versus conventional left atriotomy for mitral valve surgery. Journal of Heart Valve Disease. 1999; 8(4):440-444.
19. Gaudino M, Alessandrini F, Glieca F, Martinelli L, Santarelli P, Bruno P, et al.,. Conventional left atrial versus superior septal approach for mitral valve replacement. Annals of Thoracic Surgery. 1997; 63: 1123-7.
20. Salerno TA, Suarez MR, Panos AL, Macedo FI, Alba J, Brown M, Ricci M. Efficacy, feasibility, and pitfalls of transseptal approach in beating-heart mitral valve surgery. Journal of Cardiac Surgery. 2009; 24(5):495-8.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Sangram Keshari Behera
Associate Professor, Department of CTVS, IMS & SUM Hospital, Siksha ‘O’ Anusandhan, Deemed to be University, Bhubaneswar, Odisha, India.
Soumyadipta Mishra
Assistant Professor Department of CTVS, IMS & SUM Hospital, Siksha ‘O’ Anusandhan, Deemed to be University, Bhubaneswar, Odisha, India.
Deepak Narayan Sahoo
Associate Professor, Department of CTVS, IMS & SUM Hospital, Siksha ‘O’ Anusandhan, Deemed to be University, Bhubaneswar, Odisha, India.
Latika Kalra
DNB, CTVS, Max Super speciality, Saket Delhi