Mazine Amine, Ghoneim Aly, Bouhout Ismail, Fortin William, Berania Ilyes, L'Allier Philippe L, Garceau Patrick, Bouchard Denis
Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
Can J Cardiol. 2016 Nov;32(11):1340-1347. doi: 10.1016/j.cjca.2016.01.034. Epub 2016 Apr 7.
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.
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.
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).
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.
经主动脉间隔心肌切除术是治疗药物治疗无效的有症状肥厚性梗阻性心肌病的金标准。本研究的目的是评估经右前小切口进行微创间隔心肌切除术的早期结果。
2011年至2014年期间，24例连续患者通过4-5厘米右胸骨旁小切口接受了单纯间隔心肌切除术。将这些患者的围手术期临床和超声心动图结果与2002年至2010年期间通过正中胸骨切开术进行单纯间隔心肌切除术的26例连续患者的历史队列结果进行比较。
两组之间的年龄和性别分布相似。小切口组的主动脉交叉钳夹时间中位数为57分钟，而胸骨切开术组为43分钟（P = 0.149）。两组均无院内死亡。1例患者术中需要转为胸骨切开术。每组各有５例患者术后需要植入永久性起搏器（P = 0.999）。两组左心室流出道梯度和间隔厚度均有相似程度的降低。小切口组有2例患者（8%）观察到二尖瓣残余梗阻性收缩期前向运动，胸骨切开术组有1例患者（4%）观察到（P = 0.602）。
本研究证明了经右小切口进行经主动脉间隔心肌切除术的可行性。我们的早期结果表明，该技术产生的临床和超声心动图结果与标准胸骨切开术相似。
