The superior approach to the mitral valve--is it worthwhile?

The mitral valve was approached through a modified incision in the roof of the left atrium in 100 consecutive patients to study exposure of the valve, complications of the method and the incidence of dysrhythmia. There were five deaths: one related to difficult atrial closure and another to breakdown of the atrial suture line. Two major and two minor non-fatal haemorrhagic complications occurred. Exposure of the valve was found to be superior to that of conventional atrial incisions in the great majority of cases. When comparing the incidence of perioperative dysrhythmia in our 100 patients with that of 56 patients approached through the conventional atrial incisions, no significant differences were found even though the sinus node artery is likely to be divided when incising the roof of the left atrium.