Abstract 15370: Excellent Short-Term Outcomes Achieved With Minimally Invasive Right Infra-Axillary Incision and Transaortic Modified Morrow Procedure

Abstract

Introduction: The Morrow procedure serves as the gold standard surgical intervention for hypertrophic obstructive cardiomyopathy. However, the conventional approach has its limitations. Minimally invasive approaches have been proposed, but exposure, mitral valve disruption, and cosmetic outcomes remain challenging. This study presents a single-port mini-incision thoracotomy through the right infra-axillary region with no surgical scar on the anterior chest wall. The procedure has achieved excellent short-term surgical outcomes. Methods: A comprehensive retrospective analysis was conducted, examining clinical data from 110 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure between August 2021 and March 2023. The patient cohort comprised 62 males and 48 females, ranging in age from 15 to 71 years. Echocardiography was employed to confirm moderate mitral regurgitation in 50 patients and severe mitral regurgitation in 24 patients. Preoperatively, 102 patients exhibited systolic anterior motion (SAM). All 110 patients underwent the transaortic modified Morrow procedure, utilizing a 4-cm incision in the right infra-axillary region, with femorofemoral cardiopulmonary bypass. Results: There was no conversion to full sternotomy. Postoperative gradients across the left ventricular outflow tract were (7.7±4.3) mmHg. Impressively, extubation was successfully performed on the operating table for 102 patients, who experienced a median postoperative hospital stay of (9.2±3.0) days. Drainage volume in the first 24 hours was (160.4±56.0) ml. Postoperative septal thickness was (11.0±1.8) mm, and no iatrogenic ventricular septal perforation or residual SAM was observed. Follow-up at 3~22 months showed no major complications. Conclusions: The single-port mini-incision thoracotomy through the right infra-axillary region is a safe and effective approach for the Morrow procedure, with excellent short-term surgical outcomes and no visible surgical scar. The procedure offers several advantages, including minimal invasiveness, reduced trauma, faster recovery, and improved cosmetic outcomes. The technique is feasible and reproducible and may be a promising alternative to traditional approaches.