Lyu Congmin, Gong Dingxu, Xie Yanbo, Nie Hao, Deng Long, Li Yuan, Sοng Yunhu, Wang Xin
Center of Cardiac Surgery for Adults, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Center of Cardiac Surgery for Adults, National Clinical Research Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
J Thorac Cardiovasc Surg. 2025 Aug 13. doi: 10.1016/j.jtcvs.2025.08.004.
To assess the perioperative safety and short-term efficacy of totally thoracoscopic transmitral septal myectomy as an alternative to the conventional transaortic approach in patients with hypertrophic cardiomyopathy.
In this single-center retrospective study, between January 2022 and September 2024, 74 patients underwent totally thoracoscopic transmitral myectomy and 390 underwent transaortic myectomy. Two separate 1:1 propensity score-matched analyses were performed on the basis of key clinical and anatomical variables: one evaluating perioperative outcomes (n = 69 per group) and the other assessing follow-up echocardiographic outcomes (n = 45 per group).
Transmitral myectomy led to significant reductions in interventricular septal thickness (IVST: 14.0 [12.0, 17.0] mm), left ventricular outflow tract gradient (13.0 [8.0, 17.6] mm Hg), midventricular pressure gradient (8.0 [8.0, 14.4] mm Hg), and mitral regurgitation, with complete resolution of systolic anterior motion at discharge. These outcomes were comparable with those in the transaortic group. No in-hospital mortality occurred, and complication rates did not differ significantly. New-onset conduction disturbances-primarily left bundle branch block-were more frequent in the transmitral group but were not associated with increased rhythm-related interventions. Intensive care unit and hospital stays were significantly shorter in the transmitral group. At follow-up, left ventricular outflow tract gradient continued to decline in the transmitral group (10.0 [7.0, 14.0] mm Hg), whereas midventricular pressure gradient increased significantly in the transaortic group.
Totally thoracoscopic transmitral myectomy is a safe and effective minimally invasive alternative to the transaortic approach, offering comparable hemodynamic outcomes and enabling direct correction of mitral and subvalvular abnormalities.
