TY - JOUR

T1 - Superior transseptal approach to mitral valve is associated with a higher need for pacemaker implantation than the left atrial approach

AU - Lukac, Peter

AU - Hjortdal, Vibeke E

AU - Pedersen, Anders K

AU - Mortensen, Peter T

AU - Jensen, Henrik K

AU - Hansen, Peter S

PY - 2007/1

Y1 - 2007/1

N2 - BACKGROUND: Several studies suggest that the superior transseptal approach to mitral valve surgery leads to sinus node dysfunction. The clinical consequences are not known.METHODS: Consecutive patients undergoing surgery for mitral valve disease from November 16, 1994 through January 26, 2004 were retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis to adjust for possible confounders.RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses. The risk of pacemaker implantation because of atrioventricular conduction disturbances was not different between the groups (p = 0.178).CONCLUSIONS: The superior transseptal approach has a higher risk of clinically significant sinus node dysfunction than the left atrial approach.

AB - BACKGROUND: Several studies suggest that the superior transseptal approach to mitral valve surgery leads to sinus node dysfunction. The clinical consequences are not known.METHODS: Consecutive patients undergoing surgery for mitral valve disease from November 16, 1994 through January 26, 2004 were retrospectively evaluated. The surgeons used either the superior transseptal (group A) or left atrial approach (group B). The risk of pacemaker implantation associated with the superior transseptal approach as compared with the left atrial approach was estimated using the multivariate Cox regression analysis to adjust for possible confounders.RESULTS: We included 577 patients, 150 in group A and 427 in group B. Forty-four patients had a pacemaker implanted after the surgery; 17 in group A and 27 in group B (p = 0.010). The superior transseptal approach was an independent risk factor of pacemaker implantation in multivariate analysis (hazard ratio 2.2 [1.2 to 4.1], p = 0.014). Nineteen patients had a pacemaker implanted because of sinus node dysfunction; 9 in group A and 10 in group B (p = 0.017). Group A was an independent predictor of pacemaker implantation because of sinus node dysfunction in bivariate analyses. The risk of pacemaker implantation because of atrioventricular conduction disturbances was not different between the groups (p = 0.178).CONCLUSIONS: The superior transseptal approach has a higher risk of clinically significant sinus node dysfunction than the left atrial approach.

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Arrhythmias, Cardiac/etiology

KW - Atrioventricular Node/physiopathology

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Mitral Valve/surgery

KW - Pacemaker, Artificial

KW - Retrospective Studies

KW - Risk Factors

KW - Sinoatrial Node/physiopathology

U2 - 10.1016/j.athoracsur.2006.08.034

DO - 10.1016/j.athoracsur.2006.08.034

M3 - Journal article

C2 - 17184634

VL - 83

SP - 77

EP - 82

JO - The Annals of Thoracic Surgery

JF - The Annals of Thoracic Surgery

SN - 0003-4975

IS - 1

ER -