Minimally Invasive Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Surgical septal myectomy is the treatment of choice for patients with symptomatic hypertrophic obstructive cardiomyopathy refractory to medications. This report describes our minimally invasive approach for performing a septal myectomy via a ministernotomy that has been used at our institution for more than a decade. In particular, patient preparation, surgical technique, and clinical considerations are highlighted. Performed properly, this minimally invasive technique is a feasible and effective approach in our experience.

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Transapical septal myectomy in the beating heart via a minimally invasive approach: a feasibility study in swine

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz249 ◽

2019 ◽

Cited By ~ 1

Author(s):

Jing Fang ◽

Rui Wang ◽

Hongyun Liu ◽

Yunshu Su ◽

Jun Chen ◽

...

Keyword(s):

Minimally Invasive ◽

Hypertrophic Obstructive Cardiomyopathy ◽

Left Ventricular ◽

Beating Heart ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Aortic Cusp ◽

Septal Myectomy ◽

Custom Made ◽

The Right

Abstract OBJECTIVES The aim of this study was to establish an original transapical septal myectomy procedure that can be performed in the beating heart via a minimally invasive approach for the treatment of hypertrophic obstructive cardiomyopathy. METHODS We designed an original intracardiac septum resection device to conduct off-pump septal myectomy in swine. A subxiphoid minithoracotomy was performed to access the apex of the heart. This resection device was inserted into the left ventricular outflow tract of the heart via the apex. The basal anteroseptal myocardium beneath the right aortic cusp was identified using a combination of transoesophageal and transthoracic echocardiography and then resected and collected by the device. RESULTS Six consecutive operations were successfully and accurately performed using the custom-made device under echocardiographic guidance. All pigs survived and appeared to be normal until planned euthanasia 1 week after operation. A 300–700 mg portion of the septal myocardium was resected from the normal swine heart. Echocardiography and electrocardiogram revealed no abnormalities after resection. One exception was the fifth pig, in which mild annular regurgitation of the aortic valve occurred after repetitive resection. Postmortem necropsy demonstrated that all resections were correctly located at the basal anteroseptal septum beneath the right aortic cusp. CONCLUSIONS Our study provides the first proof-of-concept evidence for a novel beating heart transapical septal myectomy procedure, which showed promising translational potential for the treatment of hypertrophic obstructive cardiomyopathy. This procedure would probably reduce operative risks and improve outcomes and reduce the demanding expertise required to perform conventional surgical myectomy.

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A NOVEL MINIMALLY INVASIVE APPROACH FOR SURGICAL SEPTAL MYECTOMY

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2014.07.397 ◽

2014 ◽

Vol 30 (10) ◽

pp. S234

Author(s):

A. Mazine ◽

A. Ghoneim ◽

W. Fortin ◽

J. Lebon ◽

D. Bouchard

Keyword(s):

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Septal Myectomy

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Comparison between Conventional and Minimally Invasive Dynamic Hip Screws for Fixation of Intertrochanteric Fractures of the Femur

ISRN Orthopedics ◽

10.1155/2013/484289 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 2

Author(s):

A. Mahmood ◽

M. Kalra ◽

M. K. Patralekh

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Early Mobilization ◽

Dynamic Hip Screw ◽

Minimally Invasive Technique ◽

Invasive Technique ◽

Intertrochanteric Fractures ◽

Tissue Destruction ◽

Side Plate ◽

Hip Screw

Background. Intertrochanteric fractures of the proximal femur are one of the most common fractures encountered, and dynamic hip screw with a side plate is the standard treatment. We compared a minimally invasive surgical technique with the conventional surgical technique used in the fixation of intertrochanteric fractures with the dynamic hip screw (DHS) device. Methods. Thirty patients with such fractures were treated with the conventional open technique and 30 with a new minimally invasive technique. Patients in both groups were followed up for 1 year. Results. There was less blood loss, minimal soft tissue destruction, shorter hospital stay, and early mobilization with the minimally invasive technique. Conclusion. The present study finds minimally invasive technique superior to conventional (open) DHS.

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Surgical Technique: A Minimally Invasive Approach to Scapula Neck and Body Fractures

Clinical Orthopaedics and Related Research ◽

10.1007/s11999-011-1970-3 ◽

2011 ◽

Vol 469 (12) ◽

pp. 3390-3399 ◽

Cited By ~ 35

Author(s):

Erich M. Gauger ◽

Peter A. Cole

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach

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Transulcal parafascicular minimally invasive approach to deep and subcortical cavernomas: technical note

Journal of Neurosurgery ◽

10.3171/2015.12.jns152185 ◽

2016 ◽

Vol 125 (6) ◽

pp. 1360-1366 ◽

Cited By ~ 8

Author(s):

Robert A. Scranton ◽

Steve H. Fung ◽

Gavin W. Britz

Keyword(s):

White Matter ◽

Minimally Invasive ◽

Technical Difficulty ◽

Subcortical White Matter ◽

Technical Note ◽

Vascular Lesions ◽

Invasive Technique ◽

Minimally Invasive Approach ◽

Unique Challenge ◽

Invasive Approach

Cavernomas comprise 8%–15% of intracranial vascular lesions, usually supratentorial in location and superficial. Cavernomas in the thalamus or subcortical white matter represent a unique challenge for surgeons in trying to identify and then use a safe corridor to access and resect the pathology. Previous authors have described specific open microsurgical corridors based on pathology location, often with technical difficulty and morbidity. This series presents 2 cavernomas that were resected using a minimally invasive approach that is less technically demanding and has a good safety profile. The authors report 2 cases of cavernoma: one in the thalamus and brainstem with multiple hemorrhages and the other in eloquent subcortical white matter. These lesions were resected through a transulcal parafascicular approach with a port-based minimally invasive technique. In this series there was complete resection with no neurological complications. The transulcal parafascicular minimally invasive approach relies on image interpretation and trajectory planning, intraoperative navigation, cortical cannulation and subcortical space access, high-quality optics, and resection as key elements to minimize exposure and retraction and maximize tissue preservation. The authors applied this technique to 2 patients with cavernomas in eloquent locations with excellent outcomes.

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A modified, direct-lateral, minimally invasive approach to the hip. Surgical technique and preliminary results of 103 cases

Interactive Surgery ◽

10.1007/s11610-006-0002-6 ◽

2006 ◽

Vol 1 (1-4) ◽

pp. 27-32 ◽

Cited By ~ 1

Author(s):

H. Hourlier

Keyword(s):

Surgical Technique ◽

Minimally Invasive ◽

Minimally Invasive Approach ◽

Invasive Approach ◽

Preliminary Results

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MINIMALLY INVASIVE POSTEROLATERAL THORACIC CORPECTOMY

Neurosurgery ◽

10.1227/01.neu.0000340783.83964.27 ◽

2009 ◽

Vol 64 (4) ◽

pp. 746-753 ◽

Cited By ~ 27

Author(s):

Dae-Hyun Kim ◽

John E. O'Toole ◽

Alfred T. Ogden ◽

Kurt M. Eichholz ◽

John Song ◽

...

Keyword(s):

Minimally Invasive ◽

Cancer Metastasis ◽

Burst Fracture ◽

Invasive Technique ◽

Complication Rates ◽

Minimally Invasive Approach ◽

Tubular Retractor ◽

Invasive Approach ◽

Vertebral Bodies ◽

Clinical Cases

Abstract OBJECTIVE To demonstrate the feasibility of and initial clinical experience with a novel minimally invasive posterolateral thoracic corpectomy technique. METHODS Seven procedures were performed on 6 cadavers to determine the feasibility of thoracic corpectomy using a minimally invasive approach. The posterolateral thoracic corpectomies were performed with expandable 22 mm diameter tubular retractor paramedian incisions. The posterolateral aspects of the vertebral bodies were accessed extrapleurally, and complete corpectomies were performed. Intraprocedural fluoroscopy and postoperative computed tomography were used to assess the degree of decompression. In addition, 2 clinical cases of T6 burst fracture, 1 T4–T5 plasmacytoma, and 1 T12 colon cancer metastasis were treated using this minimally invasive approach. RESULTS In the cadaveric study, an average of 93% of the ventral canal and 80% of the corresponding vertebral body were removed. The pleura and intrathoracic contents were not violated. Adequate exposure was obtained to allow interbody grafting between the adjacent vertebral bodies. The procedures were successfully performed in the 4 clinical cases using a minimally invasive technique, and the patients demonstrated good outcomes. CONCLUSION Based on this study, minimally invasive posterolateral thoracic corpectomy safely and successfully allows complete spinal canal decompression without the tissue disruption associated with open thoracotomy. This approach may improve the complication rates that accompany open or even thoracoscopic approaches for thoracic corpectomy and may even allow surgical intervention in patients with significant comorbidities.

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