Transseptal approach for mitral valve surgery. A safe alternative when the need calls.

Within a 40-month period ending in June 1992, we used the transseptal approach in performing mitral valve surgery on 18 patients. The patients selected had 1 or more of the following indications: small left atrium; adhesions from previous cardiac surgery or rheumatic activity; large, organized left atrial thrombus: the need for concomitant tricuspid valve surgery; or any combination of these factors. We made the septal incision in the long axis of the fossa ovalis and extended it anteriorly and posteriorly, taking care not to injure either the aortic root or the coronary sinus. In 15 patients, we easily obtained good mitral exposure; in 3, exposure was still difficult. One patient died, but the cause of death was not related to the surgical approach. Although none of our patients had early postoperative cardiac arrhythmias, the small number in our series and the short follow-up time prevent us from predicting the effect of this incision on late postoperative cardiac arrhythmias. Therefore, we recommend limiting the transseptal approach to complex reoperations and to operations necessitating right atriotomy for concomitant procedures. It is also very useful in patients with a large, organized left atrial thrombus. Under these conditions, we conclude that using the transseptal approach for mitral valve surgery is a simple, safe, and time-saving technique.