SUPERIOR BIATRIAL SEPTOTOMY APPROACH TO T HE MITRAL-VALVE

The superior biatrial septotomy approach consists of two semicircular right atrial and septal incisions joined at the superior end of the in teratrial septum and extended across the dome of the left atrium, allo wing exposure of the mitral valve by reflecting the ventricular side u sing stay sutures. From 1991 to 1993, 81 patients underwent mitral val ve surgery by this technic. Mitral valve operation was combined with o ther cardiac procedures in 30 patients (37%) and was perfomed as a sec ond operation in 21 patients (25.9%). Duration of cardiopulmonary bypa ss and aortic occlusion was not significantly different from that of p atients operated via a conventional left atrial approach. The five hos pital deaths (6.2%) were not related to this operative approach. Only 2 patients (3.3%) whit preoperative in sinus rythm were discharged in atrial fibrillation after operation. In one patient (1.6%), atrioventr icular block appeared at late follow-up. There were no cases of bleedi ng, atrioventricular nodal dysfunction or intra-atrial shunting relate d to the approach. This approach provides excellent exposure of the mi tral valve even in unfavorable situations such as a small left atrium, dense adhesions from previous procedures or a previously implanted ao rtic prothesis, without damage to various cardiac structures due to ex cessive traction. No retractor or vena cava repair are required. These data support a wide application of the superior biatrial septotomy ap proach in mitral valve surgery.