Article Text

Extended trans-septal versus left atrial approach in mitral valve surgery: 1017 patients experience
  1. Syed Saleem Mujtaba,
  2. Stephen C Clark
  1. Correspondence to Dr Syed Saleem Mujtaba, Department of Cardiothoracic Surgery, Freeman Hospital, Newcastle upon Tyne NE7 7DN, UK; saleemmujtaba{at}


Objective The mitral valve may be accessed directly through the left atrium but visualisation can sometimes be challenging. A trans-septal interatrial approach provides better exposure and easy access for concomitant tricuspid procedures especially in difficult cases. This retrospective study evaluates the safety and effectiveness of the extended vertical trans-septal approach (EVTSA) for routine mitral valve exposure.

Method 1017 consecutive patients undergoing an isolated primary mitral valve procedure (repair/replacement) through a median sternotomy were retrospectively studied between 2000 and 2015. Up to 135 patients were operated by EVTSA (group A) while 882 patients underwent a traditional left atrial (LA, group B) approach.

Results There were 135 patients (M/F=56/79) in group A and 882 patients (M/F=398/484) in group B. Logistic EuroSCORE was significantly lower in EVTSA group (0.61 vs 0.90, p=0.000001). In the LA group there were more patients with preoperative transient ischaemic attack or stroke (94 vs 6, p=0.005). Cumulative cross-clamp time was 82 (44–212) min (EVTSA group) and 78 (30–360) min (LA group) (p=0.271) while cardiopulmonary bypass time was 107 (58–290) and 114 (43–602) min, respectively (p=0.121).

Postoperative blood loss was 415 mL (EVTSA) vs 427 mL (LA) (p=0.273). No significant difference was found in the incidence of postoperative atrial fibrillation (p=0.22) or heart block requiring permanent pacemaker (p=0.14).

Conclusion In our opinion, EVTSA to the mitral valve is safe and reproducible. It gives excellent exposure of the mitral valve under all circumstances without any significant increase in cross-clamp or bypass time, postoperative arrhythmia, heart block/pacemaker rate or bleeding.

  • mitral regurgitation
  • mitral stenosis
  • mitral valve prolapse
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  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Presented at This article has been presented at the following conferences. (1) 17th European Heart Disease and Heart Failure Congress and 2nd International Conference on Cardiovascular Medicine and Cardiac Surgery, 15–17 March 2017, London, UK; (2) 18th Annual Cardiologists Conference, 19–21 June 2017, Paris, France.

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