Minimally Invasive Surgery for Hypertrophic Obstructive Cardiomyopathy With Mitral Regurgitation

Background. To summarize the safety and effect of minimally invasive surgery for hypertrophic obstructive cardiomyopathy (HOCM) with significant mitral regurgitation through a single transaortic approach via right minithoracotomy.Methods. From 2008 to 2017, 51 HOCM patients with significant mitral regurgitation underwent minimally invasive surgery via right minithoracotomy. Preoperative peak left ventricular outflow tract pressure gradient (LVOTPG) was 96.53 +/- 28.72 mm Hg. Preoperative average interventricular septum thickness was 24.31 +/- 3.52 mm. All patients had significant mitral regurgitation with systolic anterior motion phenomenon. An oblique incision was made on the anterior wall of ascending aorta or aortic root. Modified Morrow procedure and edge-to edge mitral valvuloplasty were performed through the single transaortic approach via right minithoracotomy.Results. All patients successfully underwent the minimally invasive surgery through the single transaortic approach via right minithoracotomy. At discharge, postoperative peak LVOTPG (18.16 +/- 6.41 mm Hg) and interventricular septum thickness (14.33 +/- 1.99 mm) were significantly decreased compared with preoperative values (P < .05). All patients had no or trivial mitral regurgitation. The average peak mitral valve pressure gradient was 3.39 +/- 1.82 mm Hg. Systolic anterior motion phenomenon disappeared in all patients. During followup, peak LVOTPG was 19.27 +/- 6.10 mm Hg; average interventricular septum thickness was 14.67 +/- 1.87 mm. All patients had no or trivial mitral regurgitation. Average peak mitral valve pressure gradient was 3.04 +/- 1.52 mm Hg. No systolic anterior motion phenomenon occurred.Conclusions. Minimally invasive surgery of modified Morrow procedure and edge-to-edge mitral valvuloplasty through a single transaortic approach via right minithoracotomy could be safely and effectively applied for patients with HOCM and significant mitral regurgitation, which could also effectively eliminate systolic anterior motion phenomenon and without mitral valve stenosis. (C) 2021 by The Society of Thoracic Surgeons