Early and medium-term outcomes of Alfieri mitral valve repair in the management of systolic anterior motion during septal myectomy

Bulging subaortic septum in hypertrophic cardiomyopathy is a potential risk factor for systolic anterior motion after mitral valve repair. Systolic anterior motion may cause postoperative mitral regurgitation and left ventricular outflow tract obstruction despite conservative management. During “minimally invasive endoscopic” and “robotic” mitral repair procedures, systolic anterior motion is prevented with concomitant septal myectomy through the mitral valve orifice. Technically, the exposure of the bulging subaortic septum is traditionally done with detachment of the anterior mitral leaflet from its annulus, leaving a 2-mm rim of leaflet attached to the annulus. The leaflet is then sutured after myectomy. As an alternative technique in robotic surgery, the exposure of the subaortic septum is feasible without anterior leaflet incision with the use of dynamic atrial retractor in mitral repair procedures. Here, we present a patient who underwent concomitant robotic mitral valve repair with posterior chordal implantation, ring annuloplasty, and septal myectomy without anterior leaflet incision using the da Vinci surgical system.

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Robotic Septal Myectomy and Mitral Valve Repair for Idiopathic Hypertrophic Subaortic Stenosis with Systolic Anterior Motion

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/155698451601100213 ◽

2016 ◽

Vol 11 (2) ◽

pp. 146-149

Author(s):

Selin Bayburt ◽

Sahin Senay ◽

Ahmet Umit Gullu ◽

Muharrem Kocyigit ◽

Gultekin Karakus ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Subaortic Stenosis ◽

Systolic Anterior Motion ◽

Valve Repair ◽

Septal Myectomy

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Robotic Septal Myectomy and Mitral Valve Repair for Idiopathic Hypertrophic Subaortic Stenosis with Systolic Anterior Motion

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1097/imi.0000000000000249 ◽

2016 ◽

Vol 11 (2) ◽

pp. 146-149 ◽

Cited By ~ 1

Author(s):

Selin Bayburt ◽

Sahin Senay ◽

Ahmet Umit Gullu ◽

Muharrem Kocyigit ◽

Gultekin Karakus ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Interventricular Septum ◽

Posterior Wall ◽

Subaortic Stenosis ◽

Systolic Anterior Motion ◽

Posterior Leaflet ◽

Anterior Leaflet ◽

Valve Repair ◽

Septal Myectomy

Combined therapeutic approach with performing mitral valve repair may be necessitated for the treatment of idiopathic hypertrophic subaortic stenosis (IHSS) with systolic anterior motion. This report includes operative technique for combined robotic septal myectomy and mitral valve repair. A 45-year-old man with IHSS was admitted to our center for surgical intervention. The transthoracic echocardiography showed typical asymmetric ventricular hypertrophy. Left ventricle posterior wall thickness was 11 mm, and interventricular septum thickness was 21 mm. Mitral valve leaflets were found to be elongated. Mild-to-severe mitral regurgitation was detected with eccentric mitral jet. Aortic peak gradient was 128 mm Hg. Robotic mitral repair and septal myectomy through left atrial exposure was performed. The anterior leaflet was detached, and the septal muscle in a mass of 1 × 0.7 × 0.5 cm was resected. Next, the anterior leaflet was reattached with continuous suture. The plication of the posterior leaflet with transverse incision was performed to diminish the length of posterior leaflet. After the magic suture for posteromedial commissure was performed, a 34 Medtronic Future ring was implanted for mitral annuloplasty. Postoperative course was uneventful. The patient was discharged on the sixth postoperative day. Combined robotic septal myectomy and mitral valve repair for IHSS with systolic anterior motion may be feasible.

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