The extended transseptal approach in complex mitral valve surgery--evaluation of risks and benefits.

The extended transseptal approach to the mitral valve was used in 32 patients undergoing isolated or combined mitral valve surgery. In all cases exposure of the entire mitral valvular apparatus was excellent. Two patients died of low output within 30 days of surgery. No cause of death was related to the extended transseptal approach. In one early patient reexploration revealed arterial bleeding from the right atrial suture line which was caused by damage to the sinus nodal artery. In 7 patients temporary atrial conduction disturbances occurred which completely resolved within 10 days after responding well to dual-chamber pacing. Temporary ventricular pacing was necessary in two patients with preoperative bradyarrhythmia. In two patients undergoing mitral re-do surgery a permanent ventricular pacer was implanted. The extended transseptal approach offers an excellent exposure of the entire mitral valve both in primary isolated or combined mitral surgery particularly in re-do surgery where the primary standard vertical left atriotomy is impeded or the conventional transseptal approach gives only limited access. Temporary atrial dysrhythmia is not crucial and is easily controlled by short-term dual-chamber pacing.