Surgical approaches to the mitral valve: a prospective comparative study of the trans-septal approach vs standard left atrial approach

ABSTRACT

Surgical exposure of the mitral valve can be achieved through various approaches depending upon various pathological features of individual case. Each of these approaches has its own merits and demerits. The criteria for selection are not well defined. The left atrial approach is standard and most commonly used approach. The next commonest approach is right atrial trans-septal approach. There is theoretical possibility of rhythm problems following tyhe trans-septal approach as it can damage the atrioventricular conduction system located in the inter-atrial-sepum. We did a comparative prospective study to evaluate the safety of trans-septal approach against the gold standard of left atrial approach. All planned mitral valve operations done between January 1991 to May 1993 were included in the study, which included 237 cases operated through left atrial and 25 through trans-septal approach. The patient characteristics and the operative procedures were similar in both groups. All patients in left atrial group were followed for four years and those in trans-septal group could not be followed beyond two years due to various reasons. The results of both groups were compared statistically. We found no statistically significant differences in post-operative characteristics between both groups. There were no conduction block or arrhythmia in trans-septal group and we therefore consider this approach as useful, safe and convenient