Application of special surgical instruments in transaortic septal
myectomy for the treatment of hypertrophic obstructive cardiomyopathy
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.