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Minimally Invasive Surgery for Hypertrophic Obstructive Cardiomyopathy With Mitral Regurgitation
Zhaolei Jiang1, Min Tang1, Hao Liu1
1Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Insights
Minimally invasive surgery for hypertrophic obstructive cardiomyopathy (HOCM) effectively reduced left ventricular outflow tract pressure gradients and mitral regurgitation. This approach safely eliminated systolic anterior motion, offering a promising treatment for HOCM patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Minimally Invasive Procedures
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) with significant mitral regurgitation presents complex surgical challenges.
- The systolic anterior motion (SAM) phenomenon is a hallmark of HOCM, contributing to mitral regurgitation.
- Traditional surgical approaches may involve significant invasiveness.
Purpose of the Study:
- To evaluate the safety and efficacy of a minimally invasive surgical technique for HOCM with significant mitral regurgitation.
- To assess the impact of the procedure on left ventricular outflow tract pressure gradients (LVOTPG) and mitral regurgitation.
- To determine the effectiveness in eliminating the SAM phenomenon.
Main Methods:
- A cohort of 51 HOCM patients with significant mitral regurgitation underwent surgery between 2008 and 2017.
- A single transaortic approach via right minithoracotomy was employed.
- Procedures included a modified Morrow procedure and edge-to-edge mitral valvuloplasty.
Main Results:
- All patients successfully completed the minimally invasive surgery.
- Postoperative LVOTPG and interventricular septum thickness were significantly reduced (P < .05).
- No or trivial mitral regurgitation and absence of SAM phenomenon were observed postoperatively and during follow-up.
Conclusions:
- Minimally invasive surgery via a single transaortic approach is safe and effective for HOCM with significant mitral regurgitation.
- The technique successfully eliminates the SAM phenomenon without causing mitral valve stenosis.
- This approach offers a viable alternative for managing complex HOCM cases.
Background:
To summarize the safety and effect of minimally invasive surgery for hypertrophic obstructive cardiomyopathy (HOCM) with significant mitral regurgitation through a single transaortic approach via right minithoracotomy.
Methods:
From 2008 to 2017, 51 HOCM patients with significant mitral regurgitation underwent minimally invasive surgery via right minithoracotomy. Preoperative peak left ventricular outflow tract pressure gradient (LVOTPG) was 96.53 ± 28.72 mm Hg. Preoperative average interventricular septum thickness was 24.31 ± 3.52 mm. All patients had significant mitral regurgitation with systolic anterior motion phenomenon. An oblique incision was made on the anterior wall of ascending aorta or aortic root. Modified Morrow procedure and edge-to-edge mitral valvuloplasty were performed through the single transaortic approach via right minithoracotomy.
Results:
All patients successfully underwent the minimally invasive surgery through the single transaortic approach via right minithoracotomy. At discharge, postoperative peak LVOTPG (18.16 ± 6.41 mm Hg) and interventricular septum thickness (14.33 ± 1.99 mm) were significantly decreased compared with preoperative values (P < .05). All patients had no or trivial mitral regurgitation. The average peak mitral valve pressure gradient was 3.39 ± 1.82 mm Hg. Systolic anterior motion phenomenon disappeared in all patients. During follow-up, peak LVOTPG was 19.27 ± 6.10 mm Hg; average interventricular septum thickness was 14.67 ± 1.87 mm. All patients had no or trivial mitral regurgitation. Average peak mitral valve pressure gradient was 3.04 ± 1.52 mm Hg. No systolic anterior motion phenomenon occurred.
Conclusions:
Minimally invasive surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach via right minithoracotomy could be safely and effectively applied for patients with HOCM and significant mitral regurgitation, which could also effectively eliminate systolic anterior motion phenomenon and without mitral valve stenosis.
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