{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T11:17:33Z","timestamp":1788002253074,"version":"build-2784847793"},"reference-count":44,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T00:00:00Z","timestamp":1786492800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Asian Cardiovasc Thorac Ann"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Surgical access to the mitral valve can be achieved through various techniques, with the transseptal (TS) and left atrial (LA) approaches being the most commonly used in mitral valve surgery (MVS). However, the optimal approach remains a subject of debate, as studies report differing perioperative and postoperative outcomes associated with each technique. This meta-analysis aims to systematically compare the clinical outcomes of TS versus LA approaches in MVS.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This meta-analysis followed the PRISMA guidelines. A comprehensive literature search of PubMed, Embase and Scopus databases was performed until June 2025. The primary outcome was permanent pacemaker (PPM) implantation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Twenty-five studies were included. The TS approach was associated with higher risk of PPM implantation (risk ratio: 1.44, 95% confidence interval [1.07\u20131.95]; P\u2009=\u20090.01), postoperative atrial fibrillation, postoperative junctional rhythm, atrioventricular block, need for temporary pacing and longer cardiopulmonary bypass time, aortic cross-clamp time (CCT), hospital-stay and bleeding. No significant differences were found in intensive care unit stay, mortality, infections, stroke and renal failure. Subgroup analysis of isolated MVS showed no differences in most outcomes except for a higher risk of PPM implantation and postoperative atrial fibrillation in the TS group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Our meta-analysis demonstrates that the TS approach is associated with longer operative times and a higher risk of postoperative conduction disturbances and PPM implantation. However, no significant differences were observed in other major clinical outcomes. These findings do not support the overall superiority of either approach, and surgical access should be individualized according to patient anatomy, procedural requirements, and surgeon experience. Further high-quality studies are needed to strengthen the available evidence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/02184923261476111","type":"journal-article","created":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T18:25:03Z","timestamp":1786559103000},"page":"642-655","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Transseptal versus left atrial approach for mitral valve surgery: A systematic review and meta-analysis"],"prefix":"10.1177","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-5747-471X","authenticated-orcid":false,"given":"Sahithi MC","family":"Paramkusam","sequence":"first","affiliation":[{"name":"Katuri Medical College and Hospital"},{"name":"Sahithi MC Paramkusam, Abhinav V Paramkusam, and Bushra Abuzayed are joint first authors."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-1968-3114","authenticated-orcid":false,"given":"Abhinav V","family":"Paramkusam","sequence":"additional","affiliation":[{"name":"Jonelta Foundation School of Medicine - UPHSD"},{"name":"Sahithi MC Paramkusam, Abhinav V Paramkusam, and Bushra Abuzayed are joint first authors."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bushra","family":"Abuzayed","sequence":"additional","affiliation":[{"name":"Sheffield Teaching Hospitals NHS Trust"},{"name":"Sahithi MC Paramkusam, Abhinav V Paramkusam, and Bushra Abuzayed are joint first authors."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Layal","family":"Omaruddin","sequence":"additional","affiliation":[{"name":"Royal College of Surgeons"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Krishna Swathi","family":"Pavuluri","sequence":"additional","affiliation":[{"name":"ESH, Surrey and Sussex Healthcare NHS Trust"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aneek","family":"Ghosh","sequence":"additional","affiliation":[{"name":"Nazareth Hospital"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aleeza","family":"Basri","sequence":"additional","affiliation":[{"name":"Liaquat University of Medical and Health Sciences"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam Bashir","family":"Malik","sequence":"additional","affiliation":[{"name":"Washington University in St Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3158-2783","authenticated-orcid":false,"given":"Sudha Vidishta","family":"Ramkhalawon","sequence":"additional","affiliation":[{"name":"SAJ Flacq Hospital, Flacq, Mauritius"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Annie-Cheilla","family":"Mukunde","sequence":"additional","affiliation":[{"name":"Universidad de Montemorelos"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bashir","family":"Imam","sequence":"additional","affiliation":[{"name":"University of Pittsburgh Medical Center"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3064-4961","authenticated-orcid":false,"given":"Sudharshan Raajkumar","family":"Ezhil","sequence":"additional","affiliation":[{"name":"M.S. 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