Superior-septal Approach for Mitral Valve Surgery

It has been reported that a combination of superior and transatrioseptal approaches gives best exposure for mitral valve surgery. Although the effect of this technique on sinus node function has not been objectively evaluated in the long term, initial results are encouraging. We have used this "superior-septal" approach in 5 cases three of whom were in sinus rhythm and report our experience because of excellent exposure obtained in every case without complication related to technique. Mitral and tricuspid valve repair in two, and mitral valve replacement and tricuspid valve repair in three cases were performed. Neither complications nor a major rhythm disturbance occurred in the early postoperative period and during a mean 6 months of follow-up. Superior-septal approach should be the choice especially in cases with small left atrium, in redo cases, or if any concomitant right atrial pathology exists, when a complex repair including chordae and papillary muscles is planned, and in all cases with chronic atrial fibrillation.