Extended vertical transseptal approach in mitral valve reoperation with a small left atrium Acesso transeptal vertical ampliado em reoperações valvares mitrais com átrio esquerdo pequeno

Objective: Evaluate the efficacy of the extended vertical transseptal approach in mitral valve reoperation with a small left atrium. Method: From January 2001 to December 2002, 15 patients with previous mitral operation, small left atrium and atrial fibrillation underwent mitral valve surgery through an extended vertical transseptal incision. There were nine women and six men. Their ages ranged from 22 to 48 years. The main surgical indication was mitral prosthetic dysfunction in six patients, pure mitral regurgitation in five and mitral stenosis with regurgitation in four. Three patients had associated aortic regurgitation and one patient had associated tricuspid regurgitation. Nine patients (60%) were in congestive heart failure function class III (NYHA) and 6 patients (40%) in function class IV. Results: In all patients this approach provided excellent exposure. The cardiopulmonary bypass time ranged from 65 to 150 minutes (mean = 95 min). The mitral valve was replaced in 15 patients, the aortic valve in three and the tricuspid valve in one. One patient died secondary to cardiogenic shock and multiple organ failure (hospital mortality 6.6%). Another patient had pneumonia in the postoperative period (morbidity 7.1%). Ten patients remained in atrial fibrillation, three regained sinus rhythm and one was in nodal rhythm. The mean hospital stay was 8.2 days. Twelve patients (85%) have been in NYHA functional class I and two patients (15%) in functional class II. Actuarial survival rate at 22 months is 92.5%. Conclusion: The extended vertical transseptal approach provides excellent mitral valve exposure without inherent complications. Descriptors: Mitral valve, surgery. Reoperation. Heart valve prosthesis implantation, methods. Heart valve prosthesis.