Extended transseptal versus conventional left atriotomy: Early postoperative study

Background. Mitral valve operations require excellent exposure. The description of an extended vertical transseptal atriotomy by Guiraudon and associates promises to provide optimal exposure of the mitral valve. A prospective study was carried out to evaluate the merits of the extended vertical transseptal atriotomy in comparison with the conventional left atriotomy for mitral valve operations. Methods. Conventional atriotomy was performed in 24 patients (group I) whereas 65 patients underwent the extended vertical transseptal approach (group II). They were 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 junctional arrhythmia in these two groups were carried out. Results. Of the 24 patients in group I, 3 had development of transient junctional rhythm after operation, lasting less than 24 hours. None had this arrhythmia at the time of discharge. Of the 65 patients in group II, junctional 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 patients still had this junctional rhythm, with a failure to recover rate of 12% (3 of 25). Conclusions. The surgical exposure was considered excellent and closure of the atriotomy was thought to be easy in group II. However, this should be balanced against a significant (38%) incidence of transient junctional rhythm in the early postoperative period in group II, probably from injury to sinus node artery or atrial conduction pathways.