International Society For Minimally Invasive Cardiothoracic Surgery

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Mini Thoracotomy Transaortic Myectomy With Mitral Valve Repair For Hypertrophic Obstructive Cardiomyopathy
Erica Comstock, PA-C, Zhandong Zhou, MD, PhD.
St. Joseph Hospital, Syracuse, NY, USA.

OBJECTIVE: The Morrow procedure is the standard treatment for hypertrophic obstructive cardiomyopathy associated with systolic anterior motion of the mitral valve. It is usually performed through a sternotomy with transaortic approach with or without mitral valve repair/replacement. Minimally invasive techniques have been reported either through a thoracotomy transmitral approach, or through trans aortic approach only. Based on our minimally invasive multi valve surgery experiences, we successfully performed three cases of trans aortic septal myectomy and mitral valve repair or replacement through a mini thoracotomy. This technique has not been reported in the literature.
METHODS: The surgery in the video was performed through a 6 cm incision in the third intercostal space with direct ascending aorta and femoral venous cannulation. After establishing cardiopulmonary bypass and clamping the ascending aorta, aortotomy was performed. Aortic valve leaflets were resected due to severe aortic valve stenosis. After Septal myectomy was completed, the left atriatomy was performed to expose the mitral valve leaflets. The small triangular resection of the redundant mitral valve anterior leaflets was performed through the same incision.
RESULTS: Three patients successfully completed surgery through a mini thoracotomy without conversion. The exposure of the septum and mitral valve was excellent. Two patients had their mitral valve successfully repaired without SAM. One patient required mitral valve replacement. All patients were discharged home in stable condition.
CONCLUSIONS: Combined trans aortic myectomy and mitral valve repair/replacement can be performed safely and effectively though a mini throcotomy incision with excellent results. It allows us to reduce the septal thickness and address the mitral valve pathology minimally invasively at same time. To our knowledge, combined trans aortic septal myectomy and mitral valve repair through a mini thoracotomy has not been reported in the past.

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