Department of Cardiovascular Surgery of Zhongshan Hospital Fudan University, 180 Fenglin Rd, Shanghai, 200032, China.
Department of Cardiovascular Surgery of Xiamen Branch of Zhongshan Hospital Fudan University, 668 Jinhu Road, Huli District, Xiamen, 510530, China.
J Cardiothorac Surg. 2021 Mar 17;16(1):25. doi: 10.1186/s13019-021-01403-3.
Although septal myectomy is a standard strategy for managing patients with hypertrophic obstructive cardiomyopathy (HOCM) and drug-refractory symptoms, so far, only a few experienced myectomy centers exist globally. Mainly, this can be explained by the many technical challenges presented by myectomy. From our clinical experience, applying the mini-invasive surgical instruments during myectomy potentially reduces the technical difficulty. This study reports the preliminary experience regarding transaortic septal myectomy using mini-invasive surgical instruments for managing patients with HOCM and drug-refractory symptoms; also, we evaluate the early results following myectomy.
Between March 2016 and March 2019, consecutive HOCM patients who underwent isolated transaortic septal myectomy using the mini-invasive surgical instruments were enrolled in this analysis. Intraoperative, in-hospital and follow-up results were analyzed.
We included 168 eligible patients (83 males, mean 56.8 ± 12.3 years). The midventricular obstruction was recorded in 7 (4.2%) patients. All patients underwent transaortic septal myectomy with a mean aortic cross-clamping time of 36.0 ± 8.1 min. During myectomy, 9 (5.4%) patients received repeat aortic cross-clamping. Surgical mortality was 0.6%. Notably, 5 (3.0%) patients developed complete atrioventricular block, they needed permanent pacemaker implantation. The median follow-up time was 6 months; however, no follow-up deaths occurred with a significant improvement in New York Heart Association functional status. We reported a sharp decrease in the maximum gradients from the preoperative value (11.6 ± 7.4 mmHg vs. 94.4 ± 22.6 mmHg, p < 0.001). The median degree of mitral regurgitation fell to 1.0 (vs. 3.0 preoperatively, p < 0.001) with a significant reduction in the proportion of moderate or more regurgitation (1.2% vs. 57.7%, p < 0.001).
Mini-invasive surgical instruments may be beneficial in reducing the technical challenges of transaortic septal myectomy procedure. Of note, transaortic septal myectomy using the mini-invasive surgical instruments may present with favorable results.
尽管间隔心肌切除术是治疗肥厚型梗阻性心肌病（HOCM）和药物难治性症状患者的标准策略，但迄今为止，全球只有少数经验丰富的心肌切除术中心。这主要可以解释为心肌切除术带来了许多技术挑战。根据我们的临床经验，在心肌切除术中应用微创外科器械可以降低技术难度。本研究报告了使用微创外科器械经主动脉间隔心肌切除术治疗 HOCM 和药物难治性症状患者的初步经验；并评估了心肌切除术后的早期结果。
2016 年 3 月至 2019 年 3 月，连续纳入接受经主动脉间隔心肌切除术的 HOCM 患者，该手术采用微创外科器械。分析术中、住院和随访结果。
我们纳入了 168 例符合条件的患者（83 例男性，平均年龄 56.8±12.3 岁）。7 例（4.2%）患者存在中室梗阻。所有患者均接受经主动脉间隔心肌切除术，平均主动脉阻断时间为 36.0±8.1min。在心肌切除术中，9 例（5.4%）患者需要再次主动脉阻断。手术死亡率为 0.6%。值得注意的是，5 例（3.0%）患者发生完全性房室传导阻滞，需要植入永久性起搏器。中位随访时间为 6 个月；然而，没有随访死亡发生，纽约心脏协会功能状态显著改善。我们报告最大梯度从术前值（11.6±7.4mmHg 比 94.4±22.6mmHg，p<0.001）显著降低。二尖瓣反流的中位数降至 1.0（术前为 3.0，p<0.001），中度或更严重反流的比例显著降低（1.2%比 57.7%，p<0.001）。
微创外科器械可能有助于降低经主动脉间隔心肌切除术的技术难度。值得注意的是，经主动脉间隔心肌切除术采用微创外科器械可能具有良好的效果。
