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Canadian Journal of Cardiology

A Novel Minimally Invasive Approach for Surgical Septal Myectomy

Published:February 05, 2016DOI:https://doi.org/10.1016/j.cjca.2016.01.034

      Abstract

      Background

      Transaortic septal myectomy is the gold standard for the treatment of symptomatic hypertrophic obstructive cardiomyopathy that is refractory to medical therapy. The aim of this study was to assess early outcomes of minimally invasive septal myectomy performed through a right anterior minithoracotomy.

      Methods

      Between 2011 and 2014, 24 consecutive patients underwent isolated septal myectomy through a 4-5–cm right parasternal minithoracotomy. Perioperative clinical and echocardiographic outcomes in these patients were compared with those of a historical cohort of 26 consecutive patients who underwent isolated septal myectomy performed through a median sternotomy between 2002 and 2010.

      Results

      Age and sex distribution were similar between the groups. Median aortic cross-clamp time was 57 minutes in the minithoracotomy group vs 43 minutes in the sternotomy group (P = 0.149). There was no in-hospital mortality in either group. Intraoperative conversion to sternotomy was required in 1 patient. Postoperative permanent pacemaker implantation was required in 5 patients from each group (P = 0.999). Both groups demonstrated similar reductions in left ventricular outflow tract gradient and septal thickness. Residual obstructive systolic anterior motion of the mitral valve was observed in 2 patients (8%) in the minithoracotomy group and 1 patient (4%) in the sternotomy group (P = 0.602).

      Conclusions

      This study demonstrates the feasibility of transaortic septal myectomy through a right minithoracotomy. Our early results suggest that this technique yields clinical and echocardiographic outcomes similar to those obtained with standard sternotomy.

      Résumé

      Introduction

      La myectomie septale transaortique constitue actuellement l’intervention de choix pour le traitement de la cardiomyopathie hypertrophique obstructive symptomatique réfractaire au traitement médical. Cette étude avait pour but d’évaluer les résultats thérapeutiques précoces d’une myectomie septale pratiquée par l’intermédiaire d’une minithoracotomie antérieure droite peu invasive.

      Méthodes

      De 2011 à 2014, 24 patients ont subi de manière consécutive une myectomie septale par l’intermédiaire d’une minithoracotomie parasternale droite de 4 à 5 cm de longueur. Les résultats périopératoires cliniques et échocardiographiques de ces patients ont ensuite été comparés à celles d’une cohorte de 26 patients ayant subi de manière consécutive une myectomie septale par l’intermédiaire d’une sternotomie médiane entre 2002 et 2010.

      Résultats

      La répartition selon l’âge et le sexe était semblable entre les deux groupes étudiés. Le délai médian de clampage de l’aorte a été de 57 minutes pour le groupe ayant subi la minithoracotomie vs 43 minutes pour le groupe soumis à la sternotomie (p = 0,149). Aucun décès n’est survenu au cours du séjour hospitalier. Une sternotomie a dû être réalisée en cours d’intervention chez l’un des patients devant initialement subir une minithoracotomie. L’implantation postopératoire d’un stimulateur cardiaque permanent a été nécessaire chez cinq patients de chacun des groupes (p = 0,999). Suivant l’intervention, on a constaté une réduction semblable du degré d’obstruction de la voie d’éjection ventriculaire gauche et de l’épaisseur septale chez les deux groupes. Un obstacle éjectionnel résiduel sous forme d’un mouvement systolique antérieur de la valve mitrale a été observé chez deux patients (8 %) du groupe ayant subi une minithoracotomie et chez un patient (4 %) du groupe soumis à une sternotomie (p = 0,602).

      Conclusions

      Cette étude démontre la faisabilité de la myectomie septale transaortique par l’intermédiaire d’une minithoracotomie droite. Ces premiers résultats indiquent en effet que les résultats cliniques et échocardiographiques associées à cette technique sont semblables à celles associées à la sternotomie habituelle.
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