A. Harky, A. Noshirwani, T. Kusu-Orkar, D. Pousios, A. Muir
Publication year: 


We sought to compare the clinical outcomes of mitral valve surgerythrough conventional left atriotomy [LA] and transeptal approach [TS].


Electronic search performed from inception to March 2019. Onlyarticles including both approaches were included. Primary outcomes wereoperative times and secondary outcomes were new onset of atrial fibrillation,re-operation for bleeding, permanent pacemaker need and operative mortality.


Fifteen articles met the inclusion criteria. A total of 4,457 patientswere included (n=3,025 LA and n=1,432 TS). There were no differences inpreoperative patient demographics. No differences noted in operative mortality(OR=0.92, 95% CI [0.60, 1.40], p=0.69), rate of new onset atrial fibrilla-tion (OR=0.82, 95%CI [0.62, 1.07], p=0.15), and reoperation for bleeding(OR=0.95, 95% CI [0.58, 1.53], p=0.82). Cardiopulmonary bypass and aor-tic cross clamp times were longer with TS (130±32 vs 113±31 mins, p=0.03;88±23 vs 75±23 mins, p=0.0007 respectively), and permanent pacemaker washigher in with TS (5% vs 3%, OR 0.61, 95%CI [0.43, 0.87], p=0.006).


Transeptal approach for mitral valve surgery is associated withlonger operative times and higher postoperative pacemaker requirement; how-ever, no significant differences in other outcomes are evident. A randomizedcontrolled trial is required to confirm those findings.