General Thoracic and Cardiovascular Surgery

, Volume 66, Issue 4, pp 243–245 | Cite as

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

  • Alberto Pozzoli
  • Luca Vicentini
  • Stefan Thelin
  • Elisabetta Lapenna
  • Leif Nilsson
  • Ottavio Alfieri
How to Do It
  • 96 Downloads

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.

Keywords

Hypertrophic cardiomyopathy Cryoenergy Transaortic myectomy Residual left ventricular outflow tract obstruction 

Notes

Compliance with ethical standards

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.

Supplementary material

Supplementary material 1 (MP4 81389 kb)

Supplementary material 2 (MP4 178905 kb)

Supplementary material 3 (MP4 53062 kb)

References

  1. 1.
    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.CrossRefPubMedGoogle Scholar
  2. 2.
    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).CrossRefPubMedGoogle Scholar
  3. 3.
    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).CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Association for Thoracic Surgery 2017

Authors and Affiliations

  1. 1.Heart Surgery UnitSan Raffaele University HospitalMilanItaly
  2. 2.Thoracic and Cardiovascular Surgery UnitUppsala University HospitalUppsalaSweden

Personalised recommendations