A paper published this week in the Journal of the American College of Cardiology described the first beating heart septal myectomies performed on patients with obstructive HCM.
The Chinese single center study enrolled 47 patients with obstructive hypertrophic cardiomyopathy. Surgeons used a minimally invasive limited anterior thoracotomy using a transapical approach. The surgeries were performed while the hearts were still beating.
Since its advent in the 1960s, myectomy has been done via sternotomy, using a transaortic approach with the patient on cardiopulmonary bypass pumping blood though the body.
The paper describes the minimally invasive nature of the surgery, and stresses the benefit of the surgeon’s ability to assess obstruction in real time, instead of having to put the patient back onto bypass if more tissue removal is necessary.
46 of the 47 patients enrolled in the trial had successful removal of their obstruction, though there was one death and there were two serious complications.
A companion editorial by Dr. Hartzell Schaff of Mayo Clinic points out that while the minimally invasive approach sounds good to patients, more than 30% of the patients who undergo myectomy at Mayo also need contemporaneous procedures in order to address valve issues, atrial fibrillation or coronary artery disease. These other procedures would not be possible using the minimally invasive approach. Also, Dr. Schaff points out that post-operative pain from a minimally invasive approach is not necessarily less than that experienced from the more invasive alternative.
In summary, this approach could prove to be a promising option for some patients, but larger studies are needed. As always, patients should consider surgical volume and consistent results when evaluating whether to undergo any surgery.
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