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Totally Thoracoscopic Trans-mitral Extended Myectomy Guided By 3d Modeling And Printing
Peijian Wei, Jian Liu, Huiming Guo.
Guangdong Cardiovascular Institute, Guangzhou, China.

Objective: To summarize the therapeutic effect of total thoracoscopic trans-mitral extended myectomy for hypertrophic obstructive cardiomyopathy (HOCM) with guidance of 3D modeling and printing, and to explore a precise resection to treat HCOM.
Method: We conducted a prospective and self-controlled study. From April 2020 to August 2020, 10 patients (5 women) with HOCM, aged 16 to 58(48.80 12.21) years, with a peak left ventricular outflow tract (LVOT) pressure gradient of 39 to 135(90.50 29.48) mmHg, underwent totally thoracoscopic trans-mitral extended myectomy guided by three-dimensional modeling and printing in our institution. The extent and volume of resected septal myocardium was predicted through the preoperative planning and simulation by 3 D modeling and printing.
Results: The whole group was divided into satisfactory group (n=5) and unsatisfactory group (n=5) according to whether the actual resection volume was within 1 ml of the predicted resection volume. The weight of resected septal myocardium was 9.21 3.15 g in the satisfactory group and 8.16 4.46 g in the unsatisfactory group. Meanwhile, compared with the unsatisfactory group, the postoperative peak LVOT pressure gradient in the satisfactory group was lower (7.89 3.66 vs 17.4910.22, P=0.06), indicating that obstruction of LVOT was more effectively relieved. No systolic anterior motion (SAM) of the mitral valve was observed (80% vs 0%, P<0.01) in all patients and only mild to moderate mitral valve insufficiency were detected in 4 patients. There were no postoperative complications in the satisfactory group while one conversion to sternotomy in the unsatisfactory group.
Conclusion: Through predicting the extent and volume of resected septal myocardium in preoperative planning and simulation, HOCM can be treated precisely by totally thoracoscopic trans-mitral extended myectomy.
LEGEND: Totally thoracoscopic trans-mitral extended myectomy (A) Surgical Approaches (B) Trans-mitral View (C) Predicted resected myocardium (D) Actual resected myocardium

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