Impact of the Atrial Approach on Atrial Arrhythmia Behavior in Mitral Valve Repair/Replacement Surgery: Do the Ends Justify the Means?

Background: There are multiple surgical methods to expose the mitral valve (MV), but the most frequently used methods are the lateral left atrial and transseptal approaches or its extended superior transseptal version. The most used incision is through the left atrium behind the interatrial groove, which provides satisfactory exposure of the valve and subvalvular apparatus. However, there are circumstances that limit the versatility of this type of access, such as the presence of a small left atrium or simply the need for a greater degree of tissue dissection in the context of reoperation. The superior transeptal (TS) approach offers optimal exposure, even in the presence of hostile anatomical conditions. This approach was associated with a variety of complications, but the evidence is contradictory.

Method: We performed a retrospective review of 328 patients undergone isolated mitral valve surgery in our institution between the years 2016 and 2020. Patients were 72.54 ± 10.26 years old, 67% were male, and 33% were female. Patients who underwent other types of MV access, emergency interventions, history of cardiac arrhythmia, and use of devices for rhythm control were excluded from the present study. A total of 280 patients met the inclusion criteria; 260 received the left atrial approach, and 20 received the superior transseptal approach. The distribution of the preoperative and perioperative variables was similar. The primary endpoint was the association between the approach in mitral valve surgery and the incidence of tachyarrhythmias, Sinus node disease and need for a permanent pacemaker.

Results: There was no statistical difference in the incidence of supraventricular tachyarrhythmias and Sinus node dysfunction (p = 0.31, p = 0.39, respectively) between the two groups. Likewise, there was no difference in the permanent pacemaker implantation rate between the two groups (p = 0.29).

Conclusion: The present study found no association between the atrial approach in mitral valve surgery and a higher incidence of tachyarrhythmias, sick sinus syndrome or permanent pacemaker implantation, although our results need to be confirmed in a properly sized sample of patients.

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Artikel online veröffentlicht:
28. Januar 2023