EXTENDED TRANSSEPTAL VERSUS CONVENTIONAL LEFT ATRIOTOMY - EARLY POSTOPERATIVE STUDY

Background. Mitral valve operations require excellent exposure. The de scription of an extended vertical transseptal atriotomy by Guiraudon a nd associates promises to provide optimal exposure of the mitral valve . A prospective study was carried out to evaluate the merits of the ex tended vertical transseptal atriotomy in comparison with the conventio nal left atriotomy for mitral valve operations. Methods. Conventional atriotomy was performed in 24 patients (group I) whereas 65 patients u nderwent the extended vertical transseptal approach (group II). They w ere similar in age, sex, cause of disease, New York Heart Association functional class, left atrial size, and left ventricular function. The early postoperative rhythm changes in these two groups were compared. Statistical studies to analyze the significance of incidence of junct ional arrhythmia in these two groups were carried out. Results. Of the 24 patients in group I, 3 had development of transient junctional rhy thm after operation, lasting less than 24 hours. None had this arrhyth mia at the time of discharge. Of the 65 patients in group II, junction al rhythm was documented in 25, with a rate of occurrence of 38% (95% confidence interval, 27.6% to 52.2%). At the 6-week follow-up, 3 patie nts still had this junctional rhythm, with a failure to recover rate o f 12% (3 of 25). Conclusions. The surgical exposure was considered exc ellent and closure of the atriotomy was thought to be easy in group II . However, this should be balanced against a significant (38%) inciden ce of transient junctional rhythm in the early postoperative period in group II, probably from injury to sinus node artery or atrial conduct ion pathways.