Dong Zhiqiang, Wang Shuwei, Liu Zhifang, Han Erlei, Wu Changhao, Luo Chentao, Chen Weikang, Mei Fuyang, Lu Xiaofeng, Yan Meijuan, Wang Zhenzhen, Zhou Bing, Cui Yong
Heart Center, Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
Rehabilitation Medicine Center, Department of Anesthesiology, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, China.
JTCVS Tech. 2024 Sep 16;28:50-58. doi: 10.1016/j.xjtc.2024.09.006. eCollection 2024 Dec.
To assess the short-term outcomes of the transaortic modified Morrow procedure when performed via a minimally invasive right infra-axillary incision.
We conducted a retrospective observational study at a single center of patients diagnosed with hypertrophic obstructive cardiomyopathy from September 2021 to July 2023.
The cohort comprised 148 patients (mean age 47.2 ± 15.0 years; 59.5% male). A majority (137/148, 92.6%) presented with systolic anterior motion. All procedures were successfully completed through a 4- to 5-cm right infra-axillary incision, without requiring conversion to sternotomy. Transthoracic echocardiography demonstrated a significant reduction in maximum septal thickness from 20.9 ± 5.0 mm to 14.4 ± 3.5 mm (95% confidence interval, 5.66-7.28; < .001), and in left ventricular outflow tract gradient from 85.1 ± 50.9 mm Hg to 11.7 ± 10.3 mm Hg (95% confidence interval, 65.1-81.6; < .001). The systolic anterior motion phenomenon was completely eliminated, with no severe mitral regurgitation was observed postoperatively. No iatrogenic ventricular septal defects occurred. One hundred twenty-four (83.8%) patients were extubated in the operating room. Eight (5.4%) patients received permanent pacemaker implantation. Unfortunately, 1 patient (0.7%) died of an intraoperative subarachnoid hemorrhage.
The transaortic modified Morrow procedure, performed through a minimally invasive right infra-axillary incision, shows favorable short-term outcomes.
评估经微创右腋下切口行主动脉跨瓣改良Morrow手术的短期疗效。
我们在单一中心开展了一项回顾性观察研究，纳入了2021年9月至2023年7月期间诊断为肥厚型梗阻性心肌病的患者。
该队列包括148例患者（平均年龄47.2±15.0岁；59.5%为男性）。大多数患者（137/148，92.6%）表现为收缩期前向运动。所有手术均通过4至5厘米的右腋下切口成功完成，无需转为胸骨正中切开术。经胸超声心动图显示，最大室间隔厚度从20.9±5.0毫米显著降至14.4±3.5毫米（95%置信区间，5.66 - 7.28；<0.001），左心室流出道压差从85.1±50.9毫米汞柱降至11.7±10.3毫米汞柱（95%置信区间，65.1 - 81.6；<0.001）。收缩期前向运动现象完全消除，术后未观察到严重二尖瓣反流。未发生医源性室间隔缺损。124例（83.8%）患者在手术室拔除气管插管。有8例（5.4%）患者接受了永久性起搏器植入。不幸的是，1例患者（0.7%）死于术中蛛网膜下腔出血。
经微创右腋下切口行主动脉跨瓣改良Morrow手术显示出良好的短期疗效。
