Minimally Invasive Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Musharbash, Farah N.; Schill, Matthew R.; Henn, Matthew C.; Damiano, Ralph J.

doi:10.1097/imi.0000000000000421

Cited by 8 publications

(6 citation statements)

References 8 publications

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“…However, we believe that VATAM technique may play a role in the general acceptance of MICS in the surgical repair of HCMP. Recently, reports on transaortic septal myectomy through mini‐sternotomy have been published 14,15 . According to the authors, about 5% of patients converted to full sternotomy for better septal exposure.…”

Section: Discussionmentioning

confidence: 99%

Videoscope‐assisted transaortic myectomy in patients with hypertrophic cardiomyopathy with complex left ventricular anatomy

Park

Kim

et al. 2021

Journal of Cardiac Surgery

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Background The transaortic approach is the most common method of septal myectomy. However, difficulties arise due to a limited view of the surgical field. Here, we report our experience with videoscope‐assisted transaortic myectomy. Methods We reviewed myectomy operations that were performed between July 2015 and June 2019 at Chung‐Ang University Hospital, Seoul, South Korea. Patients who previously had cardiac surgery, alcohol septal ablation, or concomitant disease which required combined surgery, were excluded. Among the 21 patients included, 10 patients underwent videoscope‐assisted transaortic myectomy (VA group), and 11 patients underwent myectomy in a conventional manner (CO group). The preoperative data, echocardiographic images, operative records, and postoperative outcomes of these patients were reviewed. Results There were no differences in baseline characteristics between groups VA and CO. The main indications for videoscope‐assisted transaortic myectomy in group VA were midventricular septal muscle resection (70%), abnormal papillary muscle resection (40%), and abnormal chordal connection resection (30%). Eight (80%) patients had multiple indications for videoscope‐assisted transaortic myectomy. There was no surgical mortality in either group. Postoperative patients showed less than moderate mitral regurgitation and a New York Heart Association class either III or IV. There were no differences in hospital days (9.5 vs. 12.0 days; p = .383), nor postoperative pressure gradient (14 vs. 15 mmHg; p > .99). Conclusions Videoscope‐assisted transaortic myectomy is an effective surgical technique in selective hypertrophic cardiomyopathy patients with complex intraventricular anatomy, diffuse hypertrophy, and midventricular obstruction.

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Section: Discussionmentioning

confidence: 99%

Videoscope‐assisted transaortic myectomy in patients with hypertrophic cardiomyopathy with complex left ventricular anatomy

Park

Kim

et al. 2021

Journal of Cardiac Surgery

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“…We have previously described our minimally invasive technique via mini-sternotomy in detail [22]. The mini-sternotomy is our preferred approach and all patients who are referred for a septal myectomy are considered for it.…”

Section: Methodsmentioning

confidence: 99%

“…We have previously described our minimally invasive technique via MS in detail. 22 The MS is our preferred approach, and all patients who are referred for a septal myectomy are considered for it. The FS is usually reserved for patients with a significant leftward deviation of the aorta, patients with a previous sternotomy, and those undergoing concomitant surgery requiring a wider exposure such as mitral valve repair/replacement, coronary artery bypass grafting, or the Cox-Maze procedure for atrial fibrillation.…”

Section: Surgical Techniquementioning

confidence: 99%

Minimally Invasive versus Full-Sternotomy Septal Myectomy for Hypertrophic Cardiomyopathy

Musharbash

Schill

Hansalia

et al. 2018

Innovations�(Phila)

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Objective Septal myectomy remains the criterion standard for the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to medical therapy. There have been few reports of minimally invasive approaches. This study compared a minimally invasive septal myectomy performed at our institution with the traditional full-sternotomy approach. Methods Patients receiving a stand-alone septal myectomy were retrospectively reviewed from November 1999 to December 2016 (N = 120). Patients were stratified by surgical approach: traditional full sternotomy (n = 34) and ministernotomy (n = 86). Preoperative and perioperative variables were compared as well as follow-up symptomatic and echocardiographic outcomes. Results Both groups had a significant decrease in New York Heart Association class heart failure symptoms ( P < 0.001). At a mean ± SD follow-up time of 2.0 ± 3.4 years, postoperative New York Heart Association class distribution was similar between ministernotomy and full sternotomy ( P = 0.684). Follow-up resting left ventricular outflow tract gradient was also similar between ministernotomy and full sternotomy (11 mm Hg ± 15 vs 9 mm Hg ± 13, P = 0.381). Perioperatively, ministernotomy was not significantly different from full sternotomy in median cardiopulmonary bypass time (81 minutes vs 78 minutes, P = 0.101) but had a slightly longer median cross-clamp time (39 minutes vs 35 minutes, P = 0.017). Major complications were similar in the two groups. There was one 30-day mortality in the full-sternotomy group, but no in-hospital deaths. Conclusions Septal myectomy performed using a minimally invasive approach has similar outcomes to the criterion standard operation done through a full sternotomy. It represents a feasible option for patients with hypertrophic obstructive cardiomyopathy unresponsive to medications.

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“…Помимо стандартного доступа, возможно применение миниинвазивного доступа с частичной верх-несрединной стернотомией при коррекции ГКМП [11].…”

Section: оригинальные статьиunclassified

Surgical treatment of patients with obstructive hypertrophic cardiomyopathy

Lysenko

Lednev

Salagaev

et al. 2019

Khir. Z. im. N.I. Pirogova

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Цель исследования-проанализировать госпитальные результаты хирургического лечения больных с обструктивной гипер трофической кардиомиопатией. Материал и методы. С ноября 2017 г. по март 2019 г. в РНЦХ им. акад. Б.В. Петровского были пролечены 15 больных (8 женщин и 6 мужчин) с обструктивной формой гипертрофической кардиомиопатии и тяжелой недостаточностью митрального клапана. Средний возраст больных составил 55,9±7,1 года. Все больные предъявляли жалобы, связанные с хронической сердечной недостаточностью на уровне III функционального класса по NYHA и относительной коронарной недостаточностью. Результаты. Хирургическая коррекция обструкции выходного тракта ЛЖ, пластика митрального клапана с устранением его переднесистолического движения были технически успешны во всех случаях. Необходимость в протезировании митрального клапана отсутствовала у всех больных. Жалобы, связанные с сердечной недостаточностью, соответствовали I-II классу по NYHA в раннем послеоперационном периоде. Выводы. Тщательное предоперационное планирование с всесторонним анализом гемодинамических и анатомических особенностей ЛЖ и, безусловно, определенный хирургический опыт являются ключевыми факторами не только адекватной коррекции обструкции ВТЛЖ (в том числе с сохранением АВ-проведения), но и сохранения нативного митрального клапана. Ключевые слова: обструктивная гипертрофическая кардиомиопатия, обструкции выходного тракта ЛЖ, митральная недостаточность, SAM-синдром, хирургическое лечение, пластика митрального клапана.

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Minimally Invasive Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Cited by 8 publications

References 8 publications

Videoscope‐assisted transaortic myectomy in patients with hypertrophic cardiomyopathy with complex left ventricular anatomy

Videoscope‐assisted transaortic myectomy in patients with hypertrophic cardiomyopathy with complex left ventricular anatomy

Minimally Invasive versus Full-Sternotomy Septal Myectomy for Hypertrophic Cardiomyopathy

Surgical treatment of patients with obstructive hypertrophic cardiomyopathy

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