Wang Qi, Wu Xianqiu, Wei Wuli, Xiang Minfeng
Department of Cardio-Thoracic Surgery, The Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, Guangxi Province, P. R. China.
Heart Surg Forum. 2014 Jun;17(3):E123-6. doi: 10.1532/HSF98.2014317.
Adequate exposure of the mitral valve is a critical factor of success for either replacement or repair of the mitral valve. In the present study, we evaluated the merits of the extended vertical transseptal approach in comparison with the transseptal approach for mitral valve operations.
A total of 72 consecutive patients operated on for mitral procedures were allocated to either group A (those operated on through an extended vertical transseptal approach [n = 38]) or group B (whose mitral valve exposure was achieved through a right atrium transseptal approach [n = 34]). The operation time, aortic cross-clamp time, first 24-hour drainage volume after the operation, and the rhythms pre- and postsurgery were compared between the 2 groups.
The mean operation time and mean cross-clamp time in group A were longer than that in group B and the drainage volume was greater in the first 24 hours, but the differences were not statistically significant. There was no surgical reexploration for bleeding in either group. For the 13 patients who had normal sinus rhythm preoperatively in group A, 2 (15.4%) developed episodes of atrial fibrillation and 1 (7.7%) developed temporary sinus bradycardia requiring temporary pacing in the immediate and early postoperative period. In group B, 2(15.4%) of patients with normal sinus rhythm before surgery developed atrial fibrillation that continued until 1 week after surgery.
The extended vertical transseptal approach not only affords excellent exposure of the mitral valve, but also is safe for maintaining sinus node function compared with the transseptal approach.
二尖瓣的充分暴露是二尖瓣置换或修复手术成功的关键因素。在本研究中，我们评估了与经房间隔途径相比，扩大垂直经房间隔途径在二尖瓣手术中的优点。
共有72例连续接受二尖瓣手术的患者被分为A组（通过扩大垂直经房间隔途径进行手术的患者[n = 38]）或B组（通过右心房经房间隔途径实现二尖瓣暴露的患者[n = 34]）。比较两组的手术时间、主动脉阻断时间、术后24小时的首次引流量以及手术前后的心律。
A组的平均手术时间和平均阻断时间长于B组，且术后24小时的引流量更大，但差异无统计学意义。两组均未因出血而进行再次手术探查。A组术前窦性心律正常的13例患者中，2例（15.4%）发生房颤，其中1例（7.7%）在术后即刻和早期发生短暂窦性心动过缓，需要临时起搏。B组术前窦性心律正常的患者中有2例（15.4%）发生房颤，持续至术后1周。
与经房间隔途径相比，扩大垂直经房间隔途径不仅能提供良好的二尖瓣暴露，而且在维持窦房结功能方面是安全的。
