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Robotic Transmitral Approach for Hypertrophic Cardiomyopathy With Systolic Anterior Motion

Nai-Kuan Chou1, Ryoi Okano1,2, Takeo Tedoriya2

  • 1Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine.

Circulation Journal : Official Journal of the Japanese Circulation Society
|September 28, 2018
PubMed

Insights

A novel robotic transmitral approach offers a less invasive option for hypertrophic cardiomyopathy (HCM) patients. This technique effectively reduces outflow obstruction and mitral regurgitation (MR) with a single incision.

Area of Science:

  • Cardiovascular Surgery
  • Minimally Invasive Techniques
  • Robotic Surgery

Background:

  • Surgical intervention is indicated for symptomatic hypertrophic cardiomyopathy (HCM) patients with significant outflow obstruction.
  • Traditional myectomy approaches (transapical, transaortic) are open procedures.
  • A robotic transmitral approach offers a less invasive alternative using a single cardiac incision.

Purpose of the Study:

  • To evaluate the feasibility and efficacy of a robotic transmitral approach for HCM.
  • To compare outcomes with the standard transaortic approach.
  • To assess the reduction of left ventricular outflow tract obstruction and mitral regurgitation (MR).

Main Methods:

  • Retrospective analysis of 20 adult patients with obstructive HCM, severe MR, and systolic anterior motion (SAM).
  • Comparison between 8 patients undergoing robotic transmitral myectomy and 12 patients undergoing standard transaortic myectomy.
  • Analysis of pre- and post-operative pressure gradients, MR severity, ejection fraction, and operative times.

Main Results:

  • Both groups showed similar pre-operative gradients, ejection fraction, and wall thickness.
  • Post-operative MR was reduced to less than grade II in all patients.
  • The robotic transmitral group demonstrated a significantly lower post-operative pressure gradient (1.5±2.6 mmHg vs. 10.6±10.8 mmHg, P=0.019) and shorter operation time (237.5±22.4 min vs. 309.6±28.5 min, P<0.01).

Conclusions:

  • The robotic transmitral approach is a feasible and reliable method for treating HCM with SAM and MR.
  • This minimally invasive technique effectively resolves septal hypertrophy and eliminates severe MR and SAM through a single atrial incision.
  • Offers a promising alternative to open-chest procedures for selected HCM patients.
Abstract

Keywords:
Hypertrophic cardiomyopathyMitral valve regurgitationRobotic surgery

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