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Application of special surgical instruments in transaortic septal myectomy for the treatment of hypertrophic obstructive cardiomyopathy
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  • Qiang Ji,
  • Yulin Wang,
  • Ye Yang,
  • hao lai,
  • WenJun Ding,
  • LiMin Xia,
  • ChunSheng Wang
Qiang Ji
Zhongshan Hospital Fudan University,
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Yulin Wang
Zhongshan Hospital Fudan University
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Ye Yang
Zhongshan Hospital Fudan University
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hao lai
Zhongshan Hospital, Fudan University
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WenJun Ding
Zhongshan Hospital Fudan University,
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LiMin Xia
Zhongshan Hospital Fudan University,
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ChunSheng Wang
Shanghai Municipal Institute for Cardiovascular Diseases
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Abstract

Background and aim: High technical difficulty has stimulated further studies regarding improving myectomy approaches and reducing the difficulty of myectomy. This study aimed to evaluate the efficacy and repeatability of transaortic septal myectomy with the aid of special surgical instruments for the treatment of hypertrophic obstructive cardiomyopathy (HOCM). Methods: Between March 2016 and March 2019, 168 HOCM patients (83 males, mean 56.8 ± 12.3 years) were included who underwent isolated transaortic septal myectomy with the aid of special surgical instruments. Intraoperative, in-hospital and follow-up results were analyzed. The incidence of major adverse events per surgeon was compared. Results: Nine (5.4%) patients received immediate repeat surgery. Surgical mortality was 0.6%. Five (3.0%) patients developed complete atrioventricular block and required permanent pacemaker implantation. The median follow-up time was 6 months. No follow-up deaths occurred with a significant improvement in New York Heart Association functional status. The maximum gradients decreased sharply from the preoperative value (11.5 ± 7.4 mmHg vs. 94.4 ± 22.6 mmHg, p<0.001). The median degree of mitral regurgitation fell to 1.0 (vs. 3.0 preoperatively, p<0.001) with a significant reduction in the proportion of moderate or more regurgitation (1.2% vs. 57.7%, p<0.001). In addition, no significant difference was found among six surgeons with varied operation volume regarding the incidence of major adverse events (p=0.739). Conclusions: The transaortic septal myectomy with the aid of special surgical instruments achieved favorable and reproducible results, and thus may be a promising treatment option for HOCM.