Conventional left atriotomy versus the superior atrial approach for mitral valve replacement

Bassem Aglan; Yousry Elsaid Rezk; Mohammed Safaan; Noha Abdelkader; Mohammed Ahmed Elgazzar

Bassem Aglan Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Yousry Elsaid Rezk Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohammed Safaan Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Noha Abdelkader Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Mohammed Ahmed Elgazzar Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

Keywords: Mitral valve replacement, Left atriotomy, Superior atrial approach, Atrial dome, Atrial fibrillation

Abstract

Background: The optimal atrial approach for exposing the mitral valve with optimized patient outcomes is still controversial. This study compared conventional left atriotomy with the superior atrial approach for mitral valve replacement (MVR).

Methods: A randomized clinical trial was conducted on 60 patients who underwent MVR during the period 2022-2024. Patients were randomized into: Group A (n= 30, left atriotomy) and Group B (n=30, superior atrial approach).

Results: The mean age in Group A was 43.17 ± 8.57 years, whereas that in Group B was 47.63 ± 10.35 years (P = 0.07). No significant differences in sex, smoking status or associated comorbidities were noted between the groups. Echocardiographic findings revealed no significant differences in left ventricular functions and dimensions. Preoperative laboratory data revealed no significant differences in hemoglobin levels, platelet counts, or INRs. The total cardiopulmonary bypass time was shorter in Group B than in Group A but did not reach a significant level (P= 0.08). The cross-clamp times were significantly shorter in Group B (64 ± 5.7 min) than in Group A (69 ± 9.5 min) (P = 0.02). There were no differences in the rate of postoperative complications or duration of hospitalization between the groups. Follow-up echocardiographic evaluations revealed no significant difference between Group A and B in regarding ejection fraction (β: -0.003, 95% CI: -0.04-0.03, P = 0.82). Similarly, the left atrial diameter decreased significantly over time (β-0.05, 95% CI: -0.07- -0.03, P < 0.001), with no significant difference between the groups (β: -0.11, 95% CI: -0.29- 0.06, P = 0.21). Changes in left ventricular end-systolic diameter decreased over time (β: -0.05, 95% CI: -0.06- -0.03, P < 0.001), with no significant difference between groups (β: -0.01, 95% CI: -0.21-0.19, P = 0.92).

Conclusions: The superior atrial approach provided comparable clinical and echocardiographic outcomes to those of left atriotomy for MVR, with shorter cross-clamp times. The superior atrial approach is a good alternative to left atriotomy with comparable safety and efficacy profiles.