Sinus Node Function after Extended Transseptal Approach for Mitral Valve Surgery: 164 Clinical Cases

Ryu, Se Min; Kim, Hyun Koo; Cho, Yang Hyun; Sim, Jae Hoon; Sohn, Young Sang; Choi, Young Ho; Kim, Hark Jei

Abstract

BACKGROUND: Extended transseptal approach can provide an excellent view of the mitral valve but the safety of this approach is controversial because this incision requires transection of the sinus node artery, which in most cases and can result postoperative arrhythmia. The purpose of this study was to evaluate perioperative and longterm conduction disturbances and the cardiac rhythms of patients who underwent an extended transseptal approach for mitral valve surgery. MATERIAL AND METHOD: Postoperative cardiac rhythms were analyzed in the 164 consecutive patients who received mitral valve replacements with a extended transseptal approach between March 1992 and July 2003. RESULT: Of the 84 patients in normal sinus rhythm, 34 (39%) had developed transient junctional rhythm and atrial fibrillation after operation, lasting less than 72 hours in most of cases. No intractable arrhythmias occurred. Most of these arrhythmia were not detected at the time of discharge and only 8 patients (9%) had atrial fibrillation at discharge. Postoperative PR intervals increased for 1 week, then decreased within 2 weeks postoperatively, and returned to normal range by 6 months postoperatively. During the postoperative period, 4 of the 78 patients with preoperative atrial fibrillation developed normal sinus thythm.
CONCLUSION
The postoperative arrhythmias were temporary and showed no significant complications after extended transseptal approach for the mitral valve surgery.