THE TRANSSEPTAL APPROACH FOR MITRAL-VALVE REPLACEMENT REVISITED

We describe our experience with the transseptal approach for mitral va lve replacement, a technique that we applied especially in cases of 3r d and 4th operations wherein numerous adhesions made the usual left at rial approach difficult. We report 39 cases of mitral procedures in wh ich we used 3 slightly different transseptal approaches, depending on the cardiac anatomy and the preferences of the surgeon. There were no complications associated with any of these approaches. Indeed they mad e the mitral valve procedure easier, because they enabled full exposur e of the mitral valvular and subvalvular apparatus. We also propose th e transseptal approach as a very safe and reproducible technique for u se in patients with friable tissues, heavily calcified mitral valves, or small left atria-and in patients who must undergo combined tricuspi d and mitral procedures. In this series, there were no conduction abno rmalities secondary to the approach, nor were there any procedure-rela ted deaths.