Video-Assisted Thoracoscopic Transaortic Myectomy for Hypertrophic Obstructive Cardiomyopathy

Vanstraelen, Stijn; Vandenbrande, Jeroen; Yilmaz, Alaaddin

doi:10.1016/j.athoracsur.2020.07.054

Cited by 3 publications

(3 citation statements)

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“…Recently, Vanstraelen et al introduced their VATS transaortic septal resection through the second right intercostal space laterally to the sternum. 3 This approach allows satisfactory visibility of the septum and LVOT, but limits exposure of the MV. It should be noted that patients with structural MV abnormality may require valve replacement.…”

Section: Commentmentioning

confidence: 99%

“…1 Several surgeons have proposed minimally invasive procedures to relieve the left ventricular outflow tract (LVOT) gradients associated with HOCM. 2,3 Here, we have innovatively developed a single-port mini-incision thoracotomy through the right infra-axillary region with no surgical scar on the anterior chest wall. To date, our center has successfully relieved LVOT obstruction in 20 patients with symptomatic HOCM.…”

Section: Introductionmentioning

confidence: 99%

“…Surgery remains the gold standard for the management of hypertrophic obstructive cardiomyopathy (HOCM) with intractable symptoms 1 . Several surgeons have proposed minimally invasive procedures to relieve the left ventricular outflow tract (LVOT) gradients associated with HOCM 2,3 . Here, we have innovatively developed a single‐port mini‐incision thoracotomy through the right infra‐axillary region with no surgical scar on the anterior chest wall.…”

Section: Introductionmentioning

confidence: 99%

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Minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy

Wang

Zhou

et al. 2022

Journal of Cardiac Surgery

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Extended left ventricular septal myectomy remains the gold standard for the treatment of hypertrophic obstructive cardiomyopathy (HOCM) with refractory symptoms. On the basis of traditional modified transaortic Morrow myectomy, we innovatively performed a minimally invasive, video-assisted single-port thoracotomy through the right infra-axillary region. Our procedure can provide good visualization of the left ventricular outflow tract and hypertrophic ventricular septum for accurate resection. It also ensures optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures.

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Section: Commentmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy

Wang

Zhou

et al. 2022

Journal of Cardiac Surgery

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Thoracoscopic trans-mitral myectomy for hypertrophic obstructive cardiomyopathy: a retrospective single-centre study

Wei

Tan

et al. 2022

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Transaortic myectomy is a common procedure for patients with hypertrophic obstructive cardiomyopathy (HOCM). Thoracoscopic trans-mitral myectomy has been described in a few small-sample studies and has been recommended as preferable. We herein report our clinical outcomes using the thoracoscopic trans-mitral approach with 76 patients. METHODS A retrospective single-center analysis of the safety and efficacy of thoracoscopic trans-mitral myectomy by comparing the clinical outcomes with that of transaortic myectomy. RESULTS Between April 2019 and October 2021, 132 patients underwent either a transaortic (n = 56) or a thoracoscopic trans-mitral myectomy (n = 76). Compared with those in the transaortic group, patients in the trans-mitral group were more likely to be weaned off the ventilator within 24 h after surgery (80.3% vs 60.7%, P < 0.05) and to require a shorter duration of ventilation [29.01(43.91) h vs 51.12(94.96), P = 0.08] and lower transfusion rate (26.3% vs 48.2%, P < 0.05). The in-hospital mortality rate of the transaortic and trans-mitral groups was 3.6% (n = 2) and 1.3% (n = 1), respectively. No significant inter-group differences were observed regarding in-hospital mortality, the incidence of low cardiac output syndrome, or permanent pacemaker implantations. In the trans-mitral group, the thickness of the interventricular septum was significantly reduced postoperatively, with resultant relief of the left ventricular outflow tract obstruction [89.37(27.5) mmHg vs 10.51(0.65) mmHg, P < 0.01]. Transaortic myectomy also resulted in a significant reduction in left ventricular outflow tract gradient [90.41(33.31) mmHg vs 11.35(9.43) mmHg, P < 0.01]. And the incidence of residual SAM of the trans-mitral group and the transaortic group were 2.67% and 1.9%, respectively. CONCLUSIONS The thoracoscopic trans-mitral approach provides excellent exposure to the septum and anomalies of the mitral valve and papillary muscle. It relieves obstruction effectively, without increasing the incidence of major complications.

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Midterm Outcomes of Percutaneous Intramyocardial Septal Radiofrequency Ablation for Hypertrophic Cardiomyopathy: A Single‐Center, Observational Study

Xie,

Chen,

Cui

et al. 2024

JAHA

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Background Percutaneous intramyocardial septal radiofrequency ablation (PIMSRA) has been reported to be safe and effective at midterm follow‐up to treat drug‐refractory hypertrophic obstructive cardiomyopathy in a single center. However, data from other centers are lacking. This retrospective cohort study aimed to investigate the efficacy and safety of PIMSRA from another independent center. Methods and Results PIMSRA was performed in 76 patients with hypertrophic obstructive cardiomyopathy in our center from April 2020 to June 2023. The primary outcome was the reduction of left ventricular outflow tract gradient after 6 months or more post‐PIMSRA. Secondary outcomes were periprocedural major adverse clinical events. Sixty‐one patients returned to the hospital for follow‐up 6 to 30 (median, 14) months after the procedure. At the last follow‐up of the 61 patients, the maximum septal thickness decreased from a median of 23.6 (interquartile range, 20.5–26.4) to 19.1 (interquartile range, 16.0–22.1) mm ( P <0.001) and the left ventricular outflow tract peak gradient at rest decreased from a median of 70.0 (interquartile range, 29.1–107.5) to 20.0 (interquartile range, 10.8–48.8) mm Hg ( P <0.001). The percentage of patients with symptoms of New York Heart Association functional class III/IV decreased from 51% to 0%. Of all 76 patients, there was no in‐hospital or 30‐day death, no right or left branch block, and no permanent pacemaker implantation. Six (8%) patients had pericardial effusion, with 1 experiencing cardiac tamponade and ventricular fibrillation, and 1 (1%) patient developed septal branch aneurysm that was treated with coil occlusion. Conclusions PIMSRA allows for the reduction in the left ventricular outflow tract gradient and enhances symptomatic improvement, with a limited incidence of adverse events and complications among patients with hypertrophic obstructive cardiomyopathy.

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Video-Assisted Thoracoscopic Transaortic Myectomy for Hypertrophic Obstructive Cardiomyopathy

Cited by 3 publications

References 5 publications

Minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy

Minimally invasive right infra‐axillary thoracotomy for transaortic septal myectomy

Thoracoscopic trans-mitral myectomy for hypertrophic obstructive cardiomyopathy: a retrospective single-centre study

Midterm Outcomes of Percutaneous Intramyocardial Septal Radiofrequency Ablation for Hypertrophic Cardiomyopathy: A Single‐Center, Observational Study

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