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Left Atrial Roof: An Alternative Minimal Approach for Mitral Valve Surgery

Esposito, Giampiero MD; Cappabianca, Giangiuseppe MD; Bichi, Samuele MD; Patrini, Davide MD; Pellegrino, Pasquale MD

Innovations:Technology and Techniques in Cardiothoracic and Vascular Surgery: November/December 2012 - Volume 7 - Issue 6 - p 417–420
doi: 10.1097/IMI.0b013e31827e7635
Original Articles

Objective The most common surgical incisions to expose the mitral valve include a paraseptal left atriotomy or a transeptal biatrial approach. Both techniques are normally performed through a full sternotomy and bicaval cannulation. We report our experience with an alternative incision to expose the mitral valve using the left atrial roof (LAR) through a complete sternotomy or a J-shaped upper ministernotomy.

Methods Between 2007 and 2011, a total of 512 patients underwent mitral procedures using the LAR approach. A J-shaped ministernotomy was performed in 189 patients, and 61 of these had concomitant aortic valve/root procedures. A standard sternotomy was performed in 323 patients, and 126 of these had concomitant aortic valve/root procedures. The repair rate in patients with mitral regurgitation was 398 of 460 (86.5%).

Results In-hospital mortality was 2.3%. An adjunctive pericardial patch to repair the LAR was necessary in 1.9% of patients. A permanent pacemaker was necessary in 3.1% of patients. Four-year survival rate was 91% ± 4.2%. In patients who underwent mitral repair, 4-year freedom from mitral regurgitation greater than 2 was 97.4%.

Conclusions The LAR approach is a safe and effective option to perform mitral valve surgery. The limited extension of this incision and the possibility to use a single venous cannula make this approach suitable for minimally invasive isolated mitral valve procedures, whereas the proximity of the LAR to the aortic root makes this approach particularly attractive for combined mitroaortic procedures through a ministernotomy.

From the Department of Cardiac Surgery, Humanitas Gavazzeni Hospital, Bergamo, Italy.

Accepted for publication September 26, 2012.

Presented at the Annual Scientific Meeting of the International Society for Minimally Invasive Cardiothoracic Surgery, May 30 - June 2, 2012, Los Angeles, CA USA.

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Disclosure: The authors declare no conflict of interest.

Address correspondence and reprint requests to Giangiuseppe Cappabianca, MD, Flat 42 Astoria Court, 116 High Street, Purley, CR82XT, Surrey, UK. E-mail:

Copyright © 2012 by the International Society for Minimally Invasive Cardiothoracic Surgery. Unauthorized reproduction of this article is prohibited.