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

Jing Fang; Rui Wang; Hongyun Liu; Yunshu Su; Jun Chen; Xiujuan Han; Yupeng Wei; Yue Chen; Lin Cheng; Xiang Wei

doi:10.1093/icvts/ivz249

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

Interact Cardiovasc Thorac Surg. 2020 Feb 1;30(2):303-311. doi: 10.1093/icvts/ivz249.

Authors

Jing Fang^{1

2

3

4}, Rui Wang¹, Hongyun Liu⁵, Yunshu Su^{1

2

3

4}, Jun Chen^{1

2

3

4}, Xiujuan Han¹, Yupeng Wei⁶, Yue Chen¹, Lin Cheng¹, Xiang Wei^{1

2

3

4}

Affiliations

¹ Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
² Key Laboratory of Organ Transplantation, Ministry of Education, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
³ NHC Key Laboratory of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁴ Key Laboratory of Organ Transplantation, Chinese Academy of Medical Sciences, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁵ Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
⁶ Department of Biological Sciences, University of Pittsburgh, Pittsburgh, PA, USA.

PMID: 31642911
DOI: 10.1093/icvts/ivz249

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.

Keywords: Hypertrophic obstructive cardiomyopathy; Minimally invasive; Septal reduction; Surgical myectomy; The Morrow procedure.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Animals
Cardiomyopathy, Hypertrophic / physiopathology
Cardiomyopathy, Hypertrophic / surgery*
Disease Models, Animal
Echocardiography
Feasibility Studies
Female
Heart Septum / diagnostic imaging
Heart Septum / surgery*
Male
Minimally Invasive Surgical Procedures / methods*
Myocardial Contraction / physiology*
Swine
Treatment Outcome