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Published on: September 9, 2020
The Actis-gouge: a simple cutting tool for proper muscular resection in hypertrophic cardiomyopathy
F Sansone1, G M Actis Dato, E Zingarelli
1Division of Cardiac Surgery, Mauriziano Umberto I Hospital, Turin, Italy. fabrisans@katamail.com
Insights
A new semicircular cutting tool effectively reduces muscle obstruction in hypertrophic cardiomyopathy (HC) patients. This innovative device improves symptoms and reduces the sub-valvular gradient safely, offering a reproducible surgical option.
Area of Science:
- Cardiovascular Surgery
- Medical Devices
- Hypertrophic Cardiomyopathy Research
Background:
- Surgical treatment of hypertrophic cardiomyopathy (HC) presents challenges due to potential complications and incomplete muscle resection.
- Developing specialized tools is crucial for improving surgical outcomes in HC.
Purpose of the Study:
- To introduce and evaluate a novel semicircular cutting device designed for precise muscular resection in HC surgery.
- To assess the safety and efficacy of this tool in reducing left ventricular outflow tract obstruction.
Main Methods:
- A semicircular cutting device was used in 10 patients undergoing surgery for HC.
- Procedures included mitral valve repair/replacement, aortic valve replacement, and ventricular myectomy.
- Patient demographics: 5 males, mean age 43.1 years (range 9-70).
Main Results:
- One early death occurred; surviving patients showed consistent symptom reduction over 2-8 years follow-up.
- Significant reduction in New York Heart Association (NYHA) class from 3.2 to 1.3 (p < 0.05).
- Effective reduction of sub-valvular gradient from 84.5 to 14.1 mmHg (p < 0.05) without atrio-ventricular block or VSD.
Conclusions:
- The semicircular myotome is an effective and safe tool for myectomy in hypertrophic cardiomyopathy.
- It enables reproducible muscular resection, reduces sub-valvular gradients, and minimizes surgical complications.
- This device shows promising results regarding morbidity and mortality in HC surgical management.
Background:
Surgical treatment of hypertrophic cardiomyopathy (HC) may be challenging for the risk of surgical complications or insufficient resection. We present our cutting tool to perform proper muscular resection in HC.
Material And Methods:
Ten patients (5 males, mean age 43,1 +/- 19,6 years, range 9-70 years) were operated on for HC using this semicircular cutting device. Combined procedures were : mitral valve repair (n = 1), mitral valve replacement (n = 2), right ventricular myectomy (n = 1), aortic valve replacement (n = 1), mitral and aortic replacement (n = 1).
Results:
There was one early death. All the surviving patients are alive over a variable follow up from 2 to 8 years, with consistent reduction of symptoms: in fact, no patient had residual angina with significant reduction of the NYHA class from 3,2 +/- 0,6 to 1,3 +/- 0,5 postoperatively (p < 0,05). Muscular resection was effective with significant reduction of sub-valvular gradient from 84.5 + 33,4 mmHg to 14,1 +/- 17,6 mmHg (p < 0,05) without complications such as complete atrio-ventricular block or ventricular septal defects.
Conclusion:
Our semicircular myotome is an effective tool to perform a safe myectomy and it avoids surgical complications such as atrio-ventricular blocks or sub-valvular injuries. Our experience suggests that this cutting tool offers a reproducible method for muscular resection and it shows appreciable effects in the reduction of sub-valvular gradient with promising results in terms of morbidity and mortality.
