Musharbash Farah N, Schill Matthew R, Hansalia Vivek H, Schuessler Richard B, Leidenfrost Jeremy E, Melby Spencer J, Damiano Ralph J
St. Luke's Hospital, Chesterfield, MO USA.
Innovations (Phila). 2018 Jul/Aug;13(4):261-266. doi: 10.1097/IMI.0000000000000536.
Septal myectomy remains the criterion standard for the treatment of patients with hypertrophic obstructive cardiomyopathy refractory to medical therapy. There have been few reports of minimally invasive approaches. This study compared a minimally invasive septal myectomy performed at our institution with the traditional full-sternotomy approach.
Patients receiving a stand-alone septal myectomy were retrospectively reviewed from November 1999 to December 2016 (N = 120). Patients were stratified by surgical approach: traditional full sternotomy (n = 34) and ministernotomy (n = 86). Preoperative and perioperative variables were compared as well as follow-up symptomatic and echocardiographic outcomes.
Both groups had a significant decrease in New York Heart Association class heart failure symptoms (P < 0.001). At a mean ± SD follow-up time of 2.0 ± 3.4 years, postoperative New York Heart Association class distribution was similar between ministernotomy and full sternotomy (P = 0.684). Follow-up resting left ventricular outflow tract gradient was also similar between ministernotomy and full sternotomy (11 mm Hg ± 15 vs 9 mm Hg ± 13, P = 0.381). Perioperatively, ministernotomy was not significantly different from full sternotomy in median cardiopulmonary bypass time (81 minutes vs 78 minutes, P = 0.101) but had a slightly longer median cross-clamp time (39 minutes vs 35 minutes, P = 0.017). Major complications were similar in the two groups. There was one 30-day mortality in the full-sternotomy group, but no in-hospital deaths.
Septal myectomy performed using a minimally invasive approach has similar outcomes to the criterion standard operation done through a full sternotomy. It represents a feasible option for patients with hypertrophic obstructive cardiomyopathy unresponsive to medications.
对于药物治疗无效的肥厚性梗阻性心肌病患者，间隔心肌切除术仍是治疗的标准方法。关于微创方法的报道较少。本研究比较了在我们机构进行的微创间隔心肌切除术与传统的全胸骨切开术。
回顾性分析1999年11月至2016年12月接受单独间隔心肌切除术的患者（N = 120）。患者按手术方式分层：传统全胸骨切开术（n = 34）和小胸骨切开术（n = 86）。比较术前和围手术期变量以及随访时的症状和超声心动图结果。
两组纽约心脏协会（NYHA）心功能分级的心力衰竭症状均显著减轻（P < 0.001）。在平均±标准差为2.0±3.4年的随访时间里，小胸骨切开术和全胸骨切开术术后NYHA分级分布相似（P = 0.684）。随访时静息左心室流出道压差在小胸骨切开术和全胸骨切开术之间也相似（11 mmHg±15与9 mmHg±13，P = 0.381）。围手术期，小胸骨切开术与全胸骨切开术的中位体外循环时间无显著差异（81分钟对78分钟，P = 此处有误，应为0.101），但中位主动脉阻断时间略长（39分钟对35分钟，P = 0.017）。两组的主要并发症相似。全胸骨切开术组有1例30天死亡，但无住院死亡。
采用微创方法进行的间隔心肌切除术与通过全胸骨切开术进行的标准手术效果相似。对于药物治疗无效的肥厚性梗阻性心肌病患者，这是一种可行的选择。
