Conventional left atriotomy versus the superior septal approach for mitral valve replacement: a clinical controlled randomized trial

Mahmoud M Abdel Azeem  Mubarak; Noha Abdelkader Nabeeh Metawea; Ahmed M  Abdelazim

Mahmoud M Abdel Azeem Mubarak Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Noha Abdelkader Nabeeh Metawea Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt
Ahmed M Abdelazim Department of Cardiothoracic Surgery, Faculty of Medicine, Banha University, Banha, Egypt

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

Abstract

Background: The most effective techniques to enhance mitral valve visualization while reducing risks associated with the procedure are still debatable. Therefore, this study compared the results of conventional left atriotomy (LA) with those of the superior septa (SS) approach for mitral valve replacement (MVR).

Methods: This randomized controlled clinical trial included patients who underwent MVR between 2024 and 2025. The participants were randomly assigned to: Group A (n=27) included patients who underwent MVR through conventional LA, and Group B (n=33) included patients who had a SS incision for MVR.

Results: The mean age in Group A was 43.04±9.02 years, whereas that in Group B was 47.33±9.92 years (P=0.09). There were no differences in sex or smoking status between the groups (P=0.73 and 0.84, respectively). No statistically significant differences were observed in the preoperative clinical, echocardiography or laboratory data. Cardiopulmonary bypass and ischemic times were shorter in patients with the SS approach (87±12 vs. 81±8 min, P=0.048 and 70±10 vs. 65±6 min, P=0.01, respectively). The vasoactive inotropic score was significantly lower in patients in Group A (P=0.04). Mechanical ventilation [9 (7–12) vs. 12 (9–12) h, P=0.02], ICU stay [3 (3–5) vs. 4 (3–5) days, P=0.09] and hospital stay [9 (8–11) vs. 11 (9–12) days, P=0.01] were shorter in patients in Group A. There were no differences in postoperative atrial fibrillation, heart block, superficial wound infection, or re-exploration for bleeding between the groups. No significant difference in changes in the ejection fraction (β: -0.002 (95%CI: -0.03-0.028), P=0.86) left atrial diameter (β: -0.11 (95%CI: -0.29-0.07), P=0.23) end-systolic diameter (β: -0.06 (95%CI: -0.27-0.14), P=0.55) between the groups.

Conclusions: Both LA and the SS approach are viable options for MVR. A SS approach was associated with shorter operative times; however, LA was associated with faster postoperative recovery, with no difference in the complication rate. Further studies with large sample sizes and longer follow-up periods are warranted.