Transmitral approach with endovideosurgical assistance in the surgery of obstructive hypertrophic cardiomyopathy from right-sided mini-thoracotomy

• Paivin A.A.
• Denisyuk D.O.
• Sichinava L.B.
• Pavlova N.E.
• Khvan D.S.
• Paivin O.A.
• Shomrotov N.N.

Abstract

Surgical treatment of obstructive hypertrophic cardiomyopathy remains the most difficult problem of modern cardiac surgery. Along with the classical transaortic access from median longitudinal sternotomy, the transmittal surgical approach from right-sided mini-thoracotomy using endovideosurgical assistance has been actively developed.

Aim. To improve the results of surgical treatment of patients with obstructive hypertrophic cardiomyopathy by applying a transmittal surgical approach from right-sided mini-thoracotomy using endovideosurgical assistance.

Material and methods. From 2019 to 2023, 27 people with obstructive hypertrophic cardiomyopathy aged 44 to 82 years were operated on at the St. Petersburg City Hospital # 40 of Kurortny District. The operation was performed by transmittal access from a right-sided mini-thoracotomy with endovideosurgical assistance.

Results. The average duration of the intervention was 200,8±32.7 minutes. In all cases a transmittal septal myoectomy was performed. In order to eliminate anterosystolic movement of the anterior flap of the mitral valve in 24 patients (88.9%), septal myoectomy was supplemented with the following techniques: reconstruction of the submitral complex of the left ventricle with resection of secondary fibrous chords – 21 (87.5%) patients and prosthetics of the mitral valve with an artificial prosthesis – 3 (12.5%). There were no deaths at the hospital stage. Complications of the postoperative period – 1 (3.7%) postoperative ventricular septal defect, 1 case of complete atrioventricular block with implantation of a permanent pacemaker. The average length of hospitalization was 8.7±3.2 days.

Keywords:obstructive hypertrophic cardiomyopathy; right-sided mini-thoracotomy; transmittal access; endovideosurgical assistance

References

1.     Dzemeshkevich S.L., Frolova Yu.V., Kim S.Yu. Anatomical and morphological signs of a diffuse-generalized form of hypertrophic cardiomyopathy. Rossiyskiy kardiologicheskiy zhurnal [Russian Journal of Cardiology]. 2015; 20 (5): 58-63. (in Russian)

2.     Morrow A.G., Brockenbrough E.S. Surgical treatment of idiopathic hypertrophic subaortic stenosis: technic and hemodynamic results of subaortic ventriculomyotomy. Ann Surg. 1961; 154: 181–9.

3.     Lillehei C.W., Levy M.J. Trans-atrial exposure for correction of sub-aortic stenosis. J Am Med Assoc. 1963; 186: 8–13.

4.     Cooley D.A., Leachman R.D., Hallman G.L., et al. Idiopathic hypertrophic subaortic stenosis. Surgical treatment including mitral valve replacement. Arch Surg. 1971; 103: 606–9.

5.     Casselman F., Vanermen H. Idiopathic hypertrophic subaortic stenosis can be treated endoscopically. J Thorac Cardiovasc Surg. 2002; 124: 1248–9.

6.     Chitwood W.R. Idiopathic hypertrophic subaortic septal obstruction: robotic trans-atrial and transmitral ventricular septal resection. Oper Tech Thorac Cardiovasc Surg. 2012; 17: 251–60.

7.     Mohr F.W., Seeburger J., Misfeld M. Keynote lecture-transmitral hypertrophic obstructive cardiomyopathy (HOCM) repair. Ann Cardiothorac Surg. 2013; 2: 729–32.

8.     Ferrazzi P., Spirito P., Binaco I. Congenital muscular mitral-aortic discontinuity identified in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol. 2002; 76: 2238–47.

9.     Chitwood W.R. Robotic trans-atrial and trans-mitral ventricular septal resection. Ann Cardiothorac Surg. 2017; 6 (1): 54–9.

10. Wei P., Liu J., Ma J., et al. Myectomy for hypertrophic obstructive cardiomyopathy in the elderly. Front Cardiovasc Med. 2022; 9: 827–60.

11. El-Sayed Ahmad A., Salamate S., Giammarino S., et al. Transmitral septal myectomy and mitral valve surgery via right mini-thoracotomy. Thorac Cardiovasc Surg. 2023; 71: 171–7.

12. Cho Y.H., Quintana E., Schaff H.B., et al. Residual and recurrent gradients after septal myectomy for hypertrophic cardiomyopathy-mechanisms of obstruction and outcomes of reoperation. J Thorac Cardiovasc Surg. 2014; 148 (3): 909–15.

13. Kunkala M.G., Schaff H.B., Nishimura R.A. Transapical approach to myectomy for midventricular obstruction in hypertrophic cardiomyopathy. Ann Thorac Surg. 2013; 96 (2): 564–70.

14. Ji Q., Wang Y.L., Yang Y., et al. Mini-invasive surgical instruments in transaortic myectomy for hypertrophic obstructive cardiomyopathy: a single-center experience with 168 cases. J Cardiothorac Surg. 2021; 16 (1): 16–25.

15. Hang D., Schaff H.B., Ommen S.R. Combined transaortic and transapical approach to septal myectomy in patients with complex hypertrophic cardiomyopathy. J Thorac Cardiovasc Surg. 2018; 155 (5): 2096–102.

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)