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)
Okano, Ryoi
Tedoriya, Takeo
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
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