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Application of cryoenergy to improve septal exposure during transaortic septal myectomy in hypertrophic obstructive cardiomyopathy

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Abstract

For the past few decades, the transaortic septal myectomy (Morrow’s procedure) has been the gold standard for treating severe left ventricular outflow tract obstruction in hypertrophic obstructive cardiomyopathy (HOCM) patients. 30-day mortality has been reported at less than 1% in dedicated centers. However, in a subgroup of patients, the interventricular septal obstruction is localized very distally, below the aortic valve plane, and the transaortic approach can be very challenging. A subset of these patients can present with residual obstruction after surgery, due to inadequate length of septal excision, leading to reoperation. The aim of this work is to illustrate an original application of cryoenergy to improve the transaortic exposure of the interventricular septum and thus enable surgeons to perform very distal myectomies in HOCM patients.

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References

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    Maron BJ, et al. Low operative mortality achieved with surgical septal myectomy: role of dedicated hypertrophic cardiomyopathy centers in the management of dynamic subaortic obstruction. J Am Coll Cardiol. 2015;66(11):1307–8. doi:10.1016/j.jacc.2015.06.1333.

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    Cho YH, et al. Residual and recurrent gradients after septal myectomy for hypertrophic cardiomyopathy-mechanisms of obstruction and outcomes of reoperation. J Thorac Cardiovasc Surg. 2014;148(3):909–15. doi:10.1016/j.jtcvs.2014.05.028 (discussion 915–6, Epub 2014 May 16).

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    Wang S, et al. Excision of anomalous muscle bundles as an important addition to extended septal myectomy for treatment of left ventricular outflow tract obstruction. J Thorac Cardiovasc Surg. 2016;152(2):461–8. doi:10.1016/j.jtcvs.2016.01.051 (Epub 2016 Feb 17).

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Author information

Correspondence to Alberto Pozzoli.

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Funding

None declared.

Conflict of interest

Alberto Pozzoli reports no conflict of interest; Luca Vicentini reports no conflict of interest; Stefan Thelin reports no conflict of interest; Elisabetta Lapenna reports no conflict of interest; Leif Nilsson reports no conflict of interest; Ottavio Alfieri reports no conflict of interest.

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Supplementary material 2 (MP4 178905 kb)

Supplementary material 3 (MP4 53062 kb)

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Pozzoli, A., Vicentini, L., Thelin, S. et al. Application of cryoenergy to improve septal exposure during transaortic septal myectomy in hypertrophic obstructive cardiomyopathy. Gen Thorac Cardiovasc Surg 66, 243–245 (2018). https://doi.org/10.1007/s11748-017-0815-8

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Keywords

  • Hypertrophic cardiomyopathy
  • Cryoenergy
  • Transaortic myectomy
  • Residual left ventricular outflow tract obstruction