Minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy

Wang, Shuwei; Wang, Zhenzhen; Zhou, Bing; Liu, Zhifang; Mei, Fuyang; Luo, Chentao; Lu, Xiaofeng; Cui, Yong

doi:10.1111/jocs.16546

Cited by 8 publications

(3 citation statements)

References 8 publications

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“…The procedure is done through a standard median sternotomy with central aortic and single venous (right atrial) cannulation. Although septal myectomy has been reported via a minimally invasive approaches such as endoscopic [6] and robotic [7], we do believe median sternotomy should be considered the gold standard for these cases as it provides adequate exposure to the heart and mediastinal structures and facilitates performing all maneuvers that are needed to facilitate exposure to the interventricular septum and performance of an adequate septal myectomy.…”

Section: Surgical Approaches For Septal Myectomymentioning

confidence: 99%

Hypertrophic Cardiomyopathy: Surgical Perspectives

Said¹,

Quintana²,

Salhab³

2024

New Insights on Cardiomyopathy

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Hypertrophic cardiomyopathy is a unique myocardial disorder that can present in all ages from neonate to adults and has strong genetic basis. Several key features characterize hypertrophic cardiomyopathy. These include: the presence of left ventricular hypertrophy that can not be explained by another etiology, and left ventricular outflow tract obstruction secondary to systolic anterior motion of the anterior mitral valve leaflet with varying degrees of mitral valve regurgitation. Surgical septal myectomy continues to be the standard line of treatment when medical therapy fails or become intolerable. We summarize in the current chapter the technical tips and pitfall of septal myectomy, its alternatives/adjuncts and its outcomes.

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Section: Surgical Approaches For Septal Myectomymentioning

confidence: 99%

Hypertrophic Cardiomyopathy: Surgical Perspectives

Said¹,

Quintana²,

Salhab³

2024

New Insights on Cardiomyopathy

View full text Add to dashboard Cite

show abstract

“…Recent advances in minimally invasive surgical techniques have potential utility for surgical myectomy [51]. Here, access is gained through limited (40 mm) right infra-axillary longitudinal incision, with further incision in the anterior-axillary line for introduction of a thoracoscope.…”

Section: Invasive Interventions For Left Ventricular Outflow Tract Ob...mentioning

confidence: 99%

“…Here, access is gained through limited (40 mm) right infra-axillary longitudinal incision, with further incision in the anterior-axillary line for introduction of a thoracoscope. The surgeons were able to adequately address submitral anomalies of aberrant papillary attachments and perform mitral valve leaflet plication with excellent acute gradient reduction [51].…”

Section: Invasive Interventions For Left Ventricular Outflow Tract Ob...mentioning

confidence: 99%

The mitral valve in hypertrophic cardiomyopathy

Malcolmson

Shipolini

Mohiddin

et al. 2023

Current Opinion in Cardiology

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Purpose of review Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities. Recent findings The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options. Summary Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.

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Perioperative echocardiography in minimally invasive surgery for hypertrophic obstructive cardiomyopathy

Wang,

Zheng

et al. 2024

J of Clinical Ultrasound

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BackgroundHypertrophic obstructive cardiomyopathy (HOCM) is clinically symptomatic and prone to malignant arrhythmias and sudden cardiac death (SCD). Currently, an effective treatment is surgical resection of the hypertrophic ventricular septum to relieve the left ventricular outflow tract (LVOT) obstruction and mitral insufficiency. Our center performs an innovative, minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy. Minimally invasive procedures rely more on perioperative transesophageal echocardiography (TEE). This study aimed to explore the use of echocardiography during the perioperative period of surgical intervention for HOCM.MethodsBetween August 2021 and April 2022, 27 patients with HOCM underwent cardiac surgery at our hospital. Minimally invasive transaortic septal resection (Morrow myectomy) was performed from the right axilla. The extent of myectomy and need for mitral valve repair were based on perioperative TEE assessment and surgical findings. The demographic parameters and clinical data of patients were recorded. The cardiopulmonary bypass time, aortic cross‐clamp, and mechanical ventilation times were calculated. TEE was used to assess ventricular wall thickening and anatomical abnormalities of mitral regurgitation, assist in intravenous catheterization, and assess the postoperative gradients of the LVOT.ResultsAmong the 27 patients with HOCM who underwent transaortic septal myectomy by minimally invasive right infra‐axillary thoracotomy, 16 had LVOT obstruction, 2 had mid‐LV obstruction, and 9 had both LVOT and mid‐LV involvement. TEE provides information about the fine structure of the LV cavity and the etiology of the obstruction. In all cases, LVOT obstruction and mitral valve systolic anterior motion were resolved postoperatively, and the degree of mitral regurgitation was significantly reduced.ConclusionPerioperative echocardiography provides valuable information regarding the complex etiology of LVOT obstruction during minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy. It helps determine the extent of septal resection and assess the need for concomitant mitral valve repair.

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Minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy

Cited by 8 publications

References 8 publications

Hypertrophic Cardiomyopathy: Surgical Perspectives

Hypertrophic Cardiomyopathy: Surgical Perspectives

The mitral valve in hypertrophic cardiomyopathy

Perioperative echocardiography in minimally invasive surgery for hypertrophic obstructive cardiomyopathy

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