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  4. Robotic Transmitral Approach for Hypertrophic Cardiomyopathy With Systolic Anterior Motion
 
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Robotic Transmitral Approach for Hypertrophic Cardiomyopathy With Systolic Anterior Motion

Journal
Circulation journal : official journal of the Japanese Circulation Society
Journal Volume
82
Journal Issue
11
Pages
2761
Date Issued
2018
Author(s)
NAI-KUAN CHOU  
Okano, Ryoi
Tedoriya, Takeo
I-HUI WU  
HSI-YU YU  
YIH-SHARNG CHEN  
MING-JIUH WANG  
NAI-HSIN CHI  
DOI
10.1253/circj.CJ-17-1369
URI
https://scholars.lib.ntu.edu.tw/handle/123456789/430917
URL
https://api.elsevier.com/content/abstract/scopus_id/85055482879
Abstract
Surgical intervention is indicated in symptomatic hypertrophic cardiomyopathy (HCM) patients with a ventricular outflow pressure gradient more than 50 mmHg. The transmitral approach, along with the transapical and transaortic approaches, is routinely used for myectomy, but all are open procedures. We describe a robotic transmitral approach that can be used to resolve septal hypertrophied muscle and eliminate mitral regurgitation (MR) using 1 cardiac incision. Methods and Results: We retrospectively analyzed 20 adult patients with obstructive HCM who exhibited concomitant severe MR and systolic anterior motion (SAM). The 2 groups comprised 12 standard full-sternotomy transaortic and 8 robotic transmitral approaches. The pre-intraventricular pressure gradient was 69±14.2 mmHg in the robotic transmitral group and 70.2±17.4 mmHg in the transaortic group (P=0.876). Both groups had a similar left ventricular ejection fraction (65±8% vs. 72±9%, P=0.901) and maximal ventricular wall thickness (22.3±4.5 and 21.7±6.0, P=0.835). Postoperative MR was reduced to less than grade II in all patients. In the robotic group, the postoperative pressure gradient was 1.5±2.6 mmHg, which was lower than that of the transaortic group at 10.6±10.8 mmHg (P=0.019). The cross-clamp time was 95.3±7.7 min in the robotic group and 104.7±20.8 min in the transaortic group (P=0.193). The operation time was 237.5±22.4 and 309.6±28.5 min (P<0.01) in the robotic transmitral and transaortic groups, respectively.
Subjects
Hypertrophic cardiomyopathy; Mitral valve regurgitation; Robotic surgery
SDGs

[SDGs]SDG3

Other Subjects
adult; Article; clinical article; cohort analysis; comparative effectiveness; diabetes mellitus; faintness; female; heart left ventricle ejection fraction; heart ventricle hypertrophy; human; hypertension; hypertrophic cardiomyopathy; male; middle aged; mitral valve regurgitation; New York Heart Association class; observational study; postoperative care; retrospective study; robot assisted surgery; systolic heart murmur; transesophageal echocardiography; aged; comparative study; heart stroke volume; heart surgery; hypertrophic cardiomyopathy; mitral valve regurgitation; pathophysiology; robotic surgical procedure; systole; Adult; Aged; Cardiac Surgical Procedures; Cardiomyopathy, Hypertrophic; Female; Humans; Male; Middle Aged; Mitral Valve Insufficiency; Retrospective Studies; Robotic Surgical Procedures; Stroke Volume; Systole
Publisher
JAPANESE CIRCULATION SOC
Type
journal article

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