Background: The extended vertical transseptal approach provides an excellent view of the mitral valve and therefore has received considerable interest. However the safety of this approach is controversial because it requires division of the sinus node artery in most cases.Methods: 60 patients undergoing mitral valve surgery at our institution were assigned for the procedure using either the extended vertical transseptal approach or the conventional left atriotomy. Postoperatively and during the follow up, 12-lead electrocardiography and 24-hour holter monitoring were performed to all patients.Results: No significant statistical difference was found between both groups as regards, cross clamp time, total bypass time and postoperative blood loss. The maintenance of sinus rhythm and the incidence of postoperative arrhythmias at early postoperative stage and at late follow up did not show significant statistical difference between the two groups.Conclusion: The use of extended vertical transseptal approach to the mitral valve is not associated with a greater incidence of rhythm disturbances or other complications. Because this approach provides optimal exposure of the valve and the subvalvular apparatus, it has been adopted for routine use in mitral valve surgery.