Abordaje transeptal para el reemplazo valvular mitral;
Transseptal Approach for Mitral Valve Replacement

ResumenIntroducciónA pesar de que es técnicamente más demandante, el acceso a la válvula mitral por vía transeptal permite una exposición mayor de sus valvas y del aparato subvalvular, en especial en aurículas pequeñas, en reoperaciones o cuando se combina con el tratamiento de la válvula tricuspídea.ObjetivosEvaluar las dificultades técnicas y las complicaciones asociadas con el abordaje transeptal para el reemplazo valvular mitral.Material y métodosEntre 2006 y 2009 se incluyeron 62 pacientes consecutivos a los que se les realizó reemplazo valvular mitral solo o asociado con revascularización miocárdica a través de un abordaje transeptal extendido al techo de la aurícula izquierda. Se evaluaron las dificultades técnicas y la morbimortalidad del procedimiento.

SUMMARYBackgroundAlthough the access to the mitral valve through transseptal approach is technically more demanding, it allows a better exposure of its leaflets and subvalvular apparatus, specially, in small atria, in reoperations or when it is combined with tricuspid valve treatment.ObjectiveTo evaluate technical difficulties and complications associated with the transseptal approach for mitral valve replacement.Material and MethodsBetween 2006 and 2009, 62 consecutive patients who underwent mitral valve replacement alone or associated with myocardial revascularization through a transseptal approach extended to the left atrial roof were included. Technical difficulties and morbimortality of the procedure were evaluated.ResultsIn all patients, the transseptal approach could be done with no technical difficulties with an appropriate exposure of the mitral valve. The rate of conduction disorders in the postoperative period was 9.7% and the need of a permanent pacemaker implantation was 4.8%. From patients who had previous atrial fibrillation (n = 18), 83.3% recovered high sinus or junctional rhythm during the postoperative period.ConclusionsThe transseptal approach extended to the left atrial roof constituted an access alternative to the mitral valve, with an exposure better than the traditional approach, at the expense of a more demanding technique. Surgical times, mortality and complications were similar to those which belong to the conventional technique, except for a probable greater incidence of junctional rhythm and AV block. Possibly, there is certain benefit in the recovery of sinus rhythm in patients with previous chronic atrial fibrillation.REV ARGENT CARDIOL 2010;78:400-404.