Minimally Invasive Surgery For Hypertrophic Obstructive Cardiomyopathy With Mitral Regurgitation Through A Single Transaortic Approach
Ju Mei, Zhaolei Jiang, Min Tang, Hao Liu, Nan Ma, Fangbao Ding, Chunrong Bao, Jianbing Huang.
Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
Objective: To summarize the safety and effect of minimally invasive surgery for hypertrophic obstructive cardiomyopathy (HOCM) with concomitantly significant mitral regurgitation (MR) through a single transaortic approach. Methods: From January 2008 to December 2017, 51 patients (female, n=22) with HOCM and significant MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. Average age was 47.04±10.98 years (14~68 years). Preoperative peak left ventricular outflow tract pressure (LVOTP) was 51~199 mmHg (average 96.53±28.72 mmHg). Preoperative interventricular septum thickness (IVST) was 17~30 mm (average 24.31±3.52 mm). The left ventricular end-diastolic diameter (LVEDD) was 36~46 mm (average 42.20±3.03 mm). All patients had significant MR with SAM phenomenon. The modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach was performed under cardiopulmonary bypass (CPB) and aortic crossclamp (ACC). An oblique incision was made on the anterior wall of the ascending aorta or aortic root. Modified Morrow procedure was performed through the orifice of aortic valve. Then, mitral valve leaflet, annulus, chordae, and papillary muscles were also exposed through the orifice of aortic valve. Edge-to-edge mitral valvuloplasty was performed with suturing the prolapsed sites between the anterior and posterior leaflet. Results: All patients successfully underwent the minimally invasive surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach. The cardiopulmonary bypass time was 65~84 min (average 72.88±6.51 min). The aortic crossclamp time was 33~39 min (36.41±1.37 min). No early death and interventricular septal perforation were occurred. At discharge, postoperative peak LVOTP (18.16±6.41 mmHg, 7~31 mmHg) and IVST (14.33±1.99 mm, 11~19 mm) were significantly decreased compared with the preoperative values (P<0.05), but LVEDD (44.27±2.88 mm, 39~50 mm) was significantly increased (P<0.05). All patients had none or trivial MR. The peak mitral valve pressure gradient (MVPG) was 0~6 mHg (average 3.39±1.82mmHg). SAM phenomenon disappeared in all patients. At a mean follow-up of 40.53±27.11 months, the peak LVOTP was 9~36 mmHg (average 19.27±6.10 mmHg); the IVST was 12~19 mm (average 14.67±1.87 mm); the LVEDD was 40~49 mm (average 43.98±2.30 mm). All patients still had none or trivial MR. The peak MVPG was 0~6 mmHg (average 3.04±1.52mmHg). No SAM phenomenon occurred. Conlusion: Minimally invasive surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach could be safely and effectively applied for patients with HOCM and concomitantly significant MR, which could also effectively eliminate SAM phenomenon and prevent mitral valve stenosis.
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