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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: Reply

Divisione di Cardiochirurgia, Policlinico Universitario A. Gemelli, Università Cattolica del S. Cuore, Largo A. Gemelli 8, 00168 Rome, Italy

e-mail: mgaudino{at}tiscalinet.it

To the Editor:

We read with interest the comments of Misawa and Kaminishi regarding our report [1]. They are to be commended for completing an interesting study on the electrophysiological consequences of the superior septal approach for mitral valve repair [2]. In this letter, Misawa and Kaminishi provide anecdotal data indicating that 97% (64/66) of patients in sinus rhythm preoperatively maintained that rhythm at long-term follow-up.

Comparison of data from different institutions located in different parts of the world with different time frames and different surgical teams is difficult and of little scientific value. Moreover, Misawa and Kaminishi do not present the preoperative and intraoperative characteristics, the indications for operation, or the operation performed on their patients. It is possible that we are talking about heterogenous patient groups undergoing different procedures. In this context, it is impossible to evaluate which factors (eg, surgical, demographic, medical) are responsible for eventual differences. Attributing minor variations in surgical technique (as the authors seem to imply) has no scientific validity. Moreover, although the maintenance of sinus rhythm seems considerably higher in their group (96.9% versus 63.5% in our study), the p value for this difference is 0.12.

We think that the data of Misawa and Kaminishi further confirm the safety of the superior septal approach. The very low incidence of clinically important rhythm disturbances related to this approach supports the results reported by us in the cited series [1] and in an earlier prospective, randomized investigation [3].

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. Gaudino M., Alessandrini F., Glieca F., et al. Conventional left atrial versus superior septal approach for mitral valve replacement. Ann Thorac Surg 1997;63:1123-1127.[Abstract/Free Full Text]

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 Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mario Gaudino Gianfederico Possati Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Gaudino, M. Articles by Possati, G. Search for Related Content PubMed Articles by Gaudino, M. Articles by Possati, G. Related Collections Valve disease