Atrial Approach in Mitral Valve Surgery: Are There Differences in the Incidence of Clinically Relevant Adverse Effects? A Propensity Analysis.

Abstract Background: The lack of evidence with respect to complications with mitral valve approaches leaves the choice of exposure to the surgeon’s preference, basing it on individual experience, speed, ease, and quality of exposure. Methods: Analysis of patients undergoing mitral valve surgery by either a superior transseptal approach or a left-atrial approach between 2006 and 2018. We included first time elective mitral valve procedures, isolated or combined, without a history of rhythm disturbances. We used propensity score matching based on 26 perioperative variables. Primary endpoint was to determine the association between the superior transeptal approach and clinically significant adverse outcomes including arrhythmias, need for permanent pacemaker, cerebrovascular events, and mortality Results: 652 patients met the inclusion criteria, 391 received the left atrial approach and 261 superior transseptal. After matching, 96 patients were compared with 69, respectively. The distribution of the preoperative and perioperative variables was similar. There was no difference in the incidence of supraventricular tachyarrhythmias and the need for treatment. The incidence of nodal rhythm (p = 0.008) and length of stay in intensive care (p = 0.04) were higher in the superior transseptal group, however the need for permanent pacemaker implantation was the same. Likewise, there was no difference in the need for anticoagulation due to arrhythmia, the incidence of cerebrovascular events or mortality in the postoperative period, and in the long-term follow-up. Conclusion: We did not find an association with permanent heart rhythm disorders or any other significant adverse clinical outcome, therefore we consider that the superior transeptal approach is useful and safe for mitral valve exposure.