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Published on: September 9, 2020
Thoracoscopic trans-mitral myectomy for hypertrophic obstructive cardiomyopathy: a retrospective single-centre study
Peijian Wei1,2, Jiexu Ma1,2, Tong Tan1
1Department of Cardiovascular Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences), Guangzhou, China.
Insights
Thoracoscopic trans-mitral myectomy offers improved outcomes for hypertrophic obstructive cardiomyopathy patients, including faster ventilation weaning and lower transfusion rates compared to transaortic myectomy. This minimally invasive approach effectively relieves left ventricular outflow tract obstruction with comparable safety.
Area of Science:
- Cardiovascular Surgery
- Minimally Invasive Cardiac Surgery
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is often treated with transaortic myectomy.
- Thoracoscopic trans-mitral myectomy (TTM) is a less invasive alternative with limited study data.
- Evaluating TTM's safety and efficacy against the standard transaortic approach is crucial.
Purpose of the Study:
- To compare the clinical outcomes of thoracoscopic trans-mitral myectomy versus transaortic myectomy in HOCM patients.
- To assess the safety and efficacy of the TTM approach in relieving left ventricular outflow tract obstruction.
Main Methods:
- Retrospective single-center analysis of 132 HOCM patients (April 2019 - October 2021).
- Comparison of clinical outcomes between 76 patients undergoing TTM and 56 patients undergoing transaortic myectomy.
- Analysis included ventilation duration, transfusion rates, in-hospital mortality, and left ventricular outflow tract gradient reduction.
Main Results:
- TTM group showed significantly higher rates of ventilator weaning within 24 hours (80.3% vs 60.7%) and lower transfusion rates (26.3% vs 48.2%).
- Both procedures effectively reduced the left ventricular outflow tract gradient, with TTM demonstrating significant septal reduction.
- In-hospital mortality and major complication rates were comparable between the two groups.
Conclusions:
- Thoracoscopic trans-mitral myectomy is a safe and effective alternative for HOCM treatment.
- The TTM approach provides excellent surgical exposure and effectively relieves obstruction.
- TTM offers potential benefits in terms of faster recovery and reduced blood transfusion requirements.
Objectives:
Transaortic myectomy is a common procedure for patients with hypertrophic obstructive cardiomyopathy. 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:
This is a retrospective single-centre 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) vs 51.12 (94.96) h, 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) 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) vs 11.35 (9.43) mmHg, P < 0.01]. And the incidence of residual systolic anterior motion of the trans-mitral group and the transaortic group was 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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