Transmitral Septal Myectomy and Mitral Valve Surgery via Right Mini-Thoracotomy

Author:

El-Sayed Ahmad Ali1,Salamate Saad1,Giammarino Sabrina1,Ciobanu Veceslav2,Bakhtiary Farhad1

Affiliation:

1. Division of Thoracic and Cardiovascular Surgery, HELIOS Klinikum Siegburg, Siegburg, Germany

2. Division of Thoracic and Cardiovascular Surgery, HELIOS Universitätsklinikum Wuppertal, Siegburg, Germany

Abstract

Abstract Background Transmitral myectomy for symptomatic hypertrophic obstructive cardiomyopathy is possible with existence of substantial mitral valve disease. We present herein our experience of minimally invasive transmitral septal myectomy combined with mitral valve surgery through right anterior mini-thoracotomy in the past 4 years at our institution. Methods Between March 2017 and October 2020, 14 patients with hypertrophic obstructive cardiomyopathy and mitral valve disease required minimally invasive transmitral septal myectomy combined with mitral valve reconstruction or replacement at our institution. Mean age of patients was 54.2 ± 11.4 and 42.9% (n = 6) were female. Twelve patients (85.1%) were in New York Heart Association class III to IV and 6 patients (42.9%) presented with persistent atrial fibrillation. Clinical data were prospectively entered into our institutional database. Results Cardiopulmonary bypass time accounted for 140.2 ± 32.6 minutes and the myocardial ischemic time was 78.5 ± 12.4 minutes. Thirty-day mortality and overall mortality were zero. Peak ventricular outflow gradient decreased from 75.2 ± 12.7 to 9.4 ± 2.3 mm Hg (p < 0.0001). Simultaneously, mitral valve reconstruction and replacement were performed in 11 (78.6%) and 3 (21.4%) patients, respectively. No systolic anterior motion was seen in patients with mitral valve repair. No conversion to full sternotomy and/or rethoracotomy was noted. During a mean follow-up period of 24 ± 13 months, no patient required reoperation, no recurrence mitral regurgitation, and left ventricular outflow tract obstruction. Conclusion Transmitral septal myectomy combined with mitral valve surgery through right anterior mini-thoracotomy can be performed safely with excellent surgical outcomes.

Publisher

Georg Thieme Verlag KG

Subject

Cardiology and Cardiovascular Medicine,Pulmonary and Respiratory Medicine,Surgery

Reference21 articles.

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3. Mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy: implications for concomitant valve procedures;J H Hong;J Am Coll Cardiol,2016

4. Surgical myectomy subaortic, midventricular, and apical;A Nguyen;Cardiol Clin,2019

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