NAI-KUAN CHOUOkano, RyoiRyoiOkanoTedoriya, TakeoTakeoTedoriyaI-HUI WUHSI-YU YUYIH-SHARNG CHENMING-JIUH WANGNAI-HSIN CHI2019-11-072019-11-0720181346-9843https://scholars.lib.ntu.edu.tw/handle/123456789/430917Surgical 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.enHypertrophic cardiomyopathy; Mitral valve regurgitation; Robotic surgery[SDGs]SDG3adult; 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; Systolejournal article10.1253/circj.CJ-17-1369302598972-s2.0-85055482879WOS:000450971300013https://api.elsevier.com/content/abstract/scopus_id/85055482879