Eur J Cardiothorac Surg. 2022 May 28:ezac328. doi: 10.1093/ejcts/ezac328. Online ahead of print.
ABSTRACT
OBJECTIVES: Concerns exist about higher rates of pacemaker implantation using the extended superior transseptal approach for mitral valve surgery. This study aims to compare the extended superior transseptal and the left-atrial approach regarding the need for pacemaker implantation after mitral valve surgery.
METHODS: We performed a retrospective analysis of the data of patients undergoing mitral valve surgery through either a sternotomy and transseptal approach or a mini-thoracotomy and left-atrial approach in a single center in the period 01/2010-05/2021. The primary outcome was the evaluation of the postoperative pacemaker implantation rate.
RESULTS: Overall, 677 patients were included, 333 with transseptal and 344 with left-atrial approach, and 58 (8.6%) patients underwent pacemaker implantation postoperatively. There was no significant difference in the rate of pacemaker implantation between the two groups [overall: 34(10.2%) vs 24(7%), p = 0.133; for sinus node dysfunction: 12(3.6%) vs 9(2.6%), p = 0.459; for high-degree atrioventricular block: 22(6.6%) vs 15(4.4%), p = 0.199; transseptal vs left-atrial approach respectively]. A subgroup analysis of the relative effect of transseptal vs left atrial approach on the rate of postoperative pacemaker implantation revealed mitral replacement as a statistically significant confounder (p = 0.019). The exclusion of patients undergoing concomitant cardiac procedures did not lead to a statistically significant difference in the pacemaker implantation rate between the two approaches.
CONCLUSIONS: The analysis of the data of these patients shows no significant difference in the rate of permanent pacemaker implantation between the extended superior transseptal and the left-atrial approach for mitral valve surgery.
PMID:35640119 | DOI:10.1093/ejcts/ezac328
