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Obando CE, Garzón JD, Ramirez LM, Castillo AC, Guerrero AF, Chalela T, Sandoval DC, Giraldo-Grueso M, Sandoval NF, Camacho J, Umaña JP. Atrial approaches in mitral valve surgery: a propensity analysis of differences in the incidence of clinically relevant adverse effects. J Cardiothorac Surg 2022; 17:341. [PMID: 36578041 PMCID: PMC9798559 DOI: 10.1186/s13019-022-02058-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 12/03/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND The lack of evidence on complications using mitral valve approaches leaves the choice of risk exposure to the surgeon's preference, based on individual experience, speed, ease, and quality of exposure. METHODS The present study analysed patients undergoing mitral valve surgery using a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first-time elective mitral valve procedures, isolated, or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. The primary endpoint was the association between the superior transeptal approach and clinically significant adverse outcomes, including arrhythmias, need for a permanent pacemaker, cerebrovascular events, and mortality. RESULTS A total of 652 patients met the inclusion criteria; 391 received the left atrial approach, and 261 received the superior transseptal approach. After matching, 96 patients were compared with 69 patients, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias or the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, but the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period or in the long-term follow-up. CONCLUSION We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome. Therefore, the superior transeptal approach is useful and safe for mitral valve exposure.
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Affiliation(s)
- Carlos E. Obando
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
| | - Javier D. Garzón
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia ,Cardiothoracic surgery, Hospital universitario mayor MEDERI, Bogotá, Colombia
| | - Lina M. Ramirez
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
| | - Andrea C. Castillo
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia ,grid.412191.e0000 0001 2205 5940General surgery Resident, Universidad del Rosario, Bogotá, Colombia
| | - Albert F. Guerrero
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia ,grid.416864.90000 0004 0435 1502Cardiothoracic Surgery, UPMC Children Hospital of Pittsburgh, Pittsburgh, USA
| | - Tomás Chalela
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
| | - Diana C. Sandoval
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
| | - Manuel Giraldo-Grueso
- grid.240416.50000 0004 0608 1972General Surgery Resident, Ochsner Medical Center, New Orleans, LA USA
| | - Nestor F. Sandoval
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
| | - Jaime Camacho
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
| | - Juan P. Umaña
- grid.412191.e0000 0001 2205 5940Cardiac Surgery Department, Fundación Cardioinfantil-Institute of Cardiology, Rosario University, Calle 163 A # 13B-60, 111831 Bogotá, Colombia
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Bourdillon A, Elder R, Lalonde M, Steele J, Gruber PJ, Geirsson A. Robotic mitral valve repair in a patient with cardiac dextroversion. JTCVS Tech 2021; 11:12-16. [PMID: 35169722 PMCID: PMC8828793 DOI: 10.1016/j.xjtc.2021.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 10/15/2021] [Indexed: 11/17/2022] Open
Affiliation(s)
| | - Robert Elder
- Section of Pediatric Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, Conn
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Conn
| | - Michael Lalonde
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Jeremy Steele
- Section of Pediatric Cardiology, Department of Pediatrics, Yale School of Medicine, New Haven, Conn
| | - Peter J. Gruber
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
| | - Arnar Geirsson
- Division of Cardiac Surgery, Department of Surgery, Yale School of Medicine, New Haven, Conn
- Address for reprints: Arnar Geirsson, MD, 330 Cedar St, Boardman 204, New Haven, CT 06519.
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