Minimally Invasive Septal Myectomy is as Effective as Sternotomy in Treating Patients with Hypertrophic Obstructive Cardiomyopathy
Jeremy E. Leidenfrost, Jennifer M. Bell, Ralph J. Damiano, Jr..
Washington University School of Medicine, Saint Louis, MO, USA.
OBJECTIVE: Hypertrophic obstructive cardiomyopathy (HOCM) can cause severe obstruction of the outflow tract. Medical treatment is the first line therapy, however septal myectomy performed through a full sternotomy has been the gold standard procedure in the treatment of HOCM unresponsive to medical therapy. Our institution has routinely used minimally invasive techniques (MIS) in patients with isolated HOCM over the last decade. The purpose of this study was to compare the outcomes of MIS to full sternotomy in these patients. To our knowledge, there have been no prior reports of the efficacy of minimally invasive septal myectomy.
METHODS: We performed a retrospective review of our prospective cardiac surgery database of patients undergoing isolated septal myectomy for HOCM. Patients were stratified by surgical approach: standard full sternotomy versus mini-sternotomy using central cannulation for cardiopulmonary bypass. Peri- and post-operative outcomes were compared between groups.
RESULTS: From January 1999 - July 2014, we performed 73 isolated septal myectomies for HOCM. Full sternotomy was used in 24 (33%) vs. 49 (67%) done via MIS. Forty-one (56%) patients were female. There were no statistical differences between groups in age 54.8±12 vs 49±14 (p=0.1), gender (p=0.08), or BMI 34±7 vs 31±6 (p=0.09). There were no differences in intraoperative variables, bypass time 81.5 ±15.8 vs. 86.0 ±21 (p=0.3), cross clamp time 38.7±14 vs 44.3±12 (p=.10), and intraoperative transfusion 50% vs 53% (p=1.0). Of the postoperative complications, CVA, heart block, atrial fibrillation and prolonged ventilation were similar between the two groups (table 1). There were no operative mortalities in either group. ICU length of stay in hours, 57.9±39.6 vs. 49.1±40.9 (p=0.39) and total length of stay in days 6.1 ±2.2 vs. 6.1±2.3 (p=0.9) were similar between the groups as well.
CONCLUSIONS: Clinical outcomes were excellent in both groups. There was no operative mortality in the series. Isolated septal myectomy through a mini-sternotomy is safe, effective, and can be performed in most patients in the hand of experienced surgeons in high volume centers.
|Variable||Full Sternotomy (n=24)||Partial sternotomy (n=49)||P-value|
|Any post-op blood product||8 (40%)||13 (33%)||0.58|
|Mean post-op RBCs (units)||0.88 ± 1.4||0.55 ± 1.2||0.31|
|Any post-op complication||10 (42%)||25 (51%)||0.47|
|Heart block||1 (4%)||2 (4%)||1.00|
|Atrial Fibrillation||6 (25%)||12 (25%)||1.00|
|Prolonged ventilation||1 (4%)||3 (6%)||1.00|
|Re-op bleeding||1 (4%)||2 (4%)||1.00|
|Any mortality||2 (8%)||0||0.11|
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