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

Abstract

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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“…There are many “tricks” for a better exposure of the interventricular septum and also for its visualization for resection, for example with the aid of a dentist's mirror. Park et al 1 report their experience with the treatment of hypertrophic cardiomyopathy with the aid of a flexible videoscope. Their technique has been partially developed previously using a rigid videoscope 2 .…”