The extended transseptal approach to the mitral valve was used in 32 patients undergoing
isolated or combined mitral valve surgery. In all cases exposure of the entire mitral
valvular apparatus was excellent. Two patients died of low Output within 30 days of
surgery. No cause of death was related to the extended transseptal approach. In one
early patient reexploration revealed arterial bleeding from the right atrial suture
line which was caused by damage to the sinus nodal artery. In 7 patients temporary
atrial conduction disturbances occurred which completely resolved within 10 days after
responding well to dualchamber pacing. Temporary ventricular pacing was necessary
in two patients with preoperative bradyarrhythmia. In two patients undergoing mitral
re-do surgery a permanent ventricular pacer was implanted. The extended transseptal
approach offers an excellent exposure of the entire mitral valve both in primary isolated
or combined mitral surgery particularly in re-do surgery where the primary Standard
vertical left atriotomy is impeded or the conventional transseptal approach gives
only limited access. Temporary atrial dysrhythmia is not crucial and is easily controlled
by short-term dual-chamber pacing.
Mitral valve surgery - Surgical approach - Transseptal approach
