An innovative minimally invasive approach for hypertrophic obstructive cardiomyopathy: Transaortic septal myectomy via right infra-axillary incision

Abstract

ObjectiveTo assess the short-term outcomes of the transaortic modified Morrow procedure when performed via a minimally invasive right infra-axillary incision. MethodsWe conducted a retrospective observational study at a single center of patients diagnosed with hypertrophic obstructive cardiomyopathy from September 2021 to July 2023. ResultsThe cohort comprised 148 patients (mean age 47.2 ± 15.0 years; 59.5% male). A majority (137/148, 92.6%) presented with systolic anterior motion. All procedures were successfully completed through a 4- to 5-cm right infra-axillary incision, without requiring conversion to sternotomy. Transthoracic echocardiography demonstrated a significant reduction in maximum septal thickness from 20.9 ± 5.0 mm to 14.4 ± 3.5 mm (95% confidence interval, 5.66-7.28; P < .001), and in left ventricular outflow tract gradient from 85.1 ± 50.9 mm Hg to 11.7 ± 10.3 mm Hg (95% confidence interval, 65.1-81.6; P < .001). The systolic anterior motion phenomenon was completely eliminated, with no severe mitral regurgitation was observed postoperatively. No iatrogenic ventricular septal defects occurred. One hundred twenty-four (83.8%) patients were extubated in the operating room. Eight (5.4%) patients received permanent pacemaker implantation. Unfortunately, 1 patient (0.7%) died of an intraoperative subarachnoid hemorrhage. ConclusionsThe transaortic modified Morrow procedure, performed through a minimally invasive right infra-axillary incision, shows favorable short-term outcomes.