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Ann Thorac Surg 2004;77:2259
© 2004 The Society of Thoracic Surgeons

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Correspondence

Early and late arrhythmias in patients in preoperative sinus rhythm after superior septal approach

Division of Cardiovascular Surgery, Jichi Medical School, Yakushiji 3311-1, Minami-kawachi, Tochigi 329-0498, Japan

e-mail: tcvmisa{at}jichi.ac.jp

To the Editor:

It was with great interest that we read the report by Gaudino and associates [1] in The Annals. They concluded that the use of the superior septal approach for mitral valve procedures in patients in preoperative sinus rhythm is associated with minor, transient cardiac rhythm disturbances. They found that the day before discharge, only 35 of 74 survivors maintained the preoperative sinus rhythm, whereas 13 had development of atrial fibrillation. During the follow-up period, the majority of patients (47/74) regained sinus rhythm, but 11 patients had atrioventricular block, 3 were in junctional rhythm, and 13 were in atrial fibrillation.

We [2, 3] also choose the superior septal approach for mitral valve surgical procedures or left atrial tumor resection. Conventional approaches such as a left atriotomy or a transseptal approach restrict the operative field, whereas the superior septal approach provides a larger operative field. Excellent visibility is important for any surgical treatment, as it helps produce successful clinical results and provide optimal educational opportunities for young surgeons. Therefore, we recommend this approach, particularly in patients who have a small left atrium or who require mitral valve plasty.

However, some procedure-related issues including postoperative conduction disturbances have been reported. Our initial experience with the superior septal approach in 27 patients in preoperative sinus rhythm showed that postoperative R-R intervals increased for 1 week but returned to a normal range within 6 months [2]. We also found that 26 patients still had sinus rhythm at 15 ± 8 months postoperatively. Atrial fibrillation developed in only 1 patient [2].

Additional experience with this approach has provided more information. The results in a total of 113 consecutive patients were analyzed [3]. Sixty-four of 66 sinus rhythm preoperatively maintained sinus rhythm, and 7 of 47 in preoperative atrial fibrillation regained sinus rhythm at final follow-up. No patient required pacemaker implantation, but 2 did have a pacemaker implanted preoperatively.

Our procedure includes a right atriotomy not going beyond the crista terminalis, an atrial septotomy beginning at the fossa ovalis, and a subsequent left atrial incision 2 to 3 cm long parallel to the superior vena cava. Is it possible that there are some differences between our procedure and that of Gaudino and co-workers? What do they think explains any differences between their late results and ours?

References

1. Gaudino M., Nasso G., Minati A., et al. Early and late arrhythmias in patients in preoperative sinus rhythm submitted to mitral valve surgery through the superior septal approach. Ann Thorac Surg 2003;75:1181-1184.[Abstract/Free Full Text]
2. Misawa Y., Fuse K., Kawahito K., Saito T., Konishi H. Conduction disturbances after superior septal approach for mitral valve repair. Ann Thorac Surg 1999;68:1262-1265.[Abstract/Free Full Text]
3. Misawa Y, Saito T, Konishi H, et al. Superior septal approach for mitral valve surgery or left atrial tumor resection. Jpn J Thorac Cardiovasc Surg 2002;50:S404–4.

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Yoshio Misawa Yuichiro Kaminishi Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Misawa, Y. Articles by Kaminishi, Y. Search for Related Content PubMed PubMed Citation Articles by Misawa, Y. Articles by Kaminishi, Y. Related Collections Valve disease