Minimally Invasive Surgery For Hypertrophic Obstructive Cardiomyopathy With Mitral Regurgitation
Ju Mei, Zhaolei Jiang, Min Tang, Nan Ma, Hao Liu
Xinhua Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China
Background: Mitral regurgitation (MR) and systolic anterior motion (SAM) phenomenon are often concomitant with hypertrophic obstructive cardiomyopathy (HOCM). Modified Morrow procedure has been proved to be effective for eliminating left ventricular outflow tract obstruction (LVOTO), whether a concomitant mitral valve (MV) surgery should be performed remains controversial for patients with HOCM and MR. The aims of this study were as following: (1) to describe the minimally invasive surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty (MVP) through a single transaortic approach via right minithoracotomy (RM); (2) to summarize the safety and effect of the minimally invasive surgery for HOCM with concomitantly significant MR through a single transaortic approach via RM.
Methods: From 2008 to 2017, 51 patients with HOCM and significant MR underwent minimally invasive surgery via RM. Preoperative peak left ventricular outflow tract pressure gradient (LVOTPG) was 96.53±28.72mmHg. Preoperative average interventricular septum thickness (IVST) was 24.31±3.52mm. All patients had significant MR with SAM phenomenon. An oblique incision was made on anterior wall of ascending aorta or aortic root. Modified Morrow procedure and edge-to-edge MVP were performed through the single transaortic approach via RM. Edge-to-edge MVP was performed with suturing the prolapsed sites between the anterior and posterior leaflet. Results: All patients successfully underwent the minimally invasive surgery through the single transaortic approach via RM. At discharge, postoperative peak LVOTPG (18.16±6.41mmHg) and IVST (14.33±1.99mm) were significantly decreased compared with preoperative values (P<0.05). All patients had none or trivial MR. The average peak mitral valve pressure gradient (MVPG) was 3.39±1.82mmHg. SAM phenomenon disappeared in all patients. During follow-up, peak LVOTPG was 19.27±6.10mmHg; average IVST was 14.67±1.87mm. All patients had none or trivial MR. Average peak MVPG was 3.04±1.52mmHg. No SAM phenomenon occurred. Conclusion: Minimally invasive surgery of modified Morrow procedure and edge-to-edge MVP through a single transaortic approach via RM could be safely and effectively applied for patients with HOCM and significant MR, which could also effectively eliminate SAM phenomenon and without mitral valve stenosis.
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