title: A Novel Minimally Invasive Approach for Surgical Septal Myectomy.
abstract: Transaortic septal myectomy is the gold standard for the treatment of symptomatic hypertrophic obstructive cardiomyopathy that is refractory to medical therapy. The aim of this study was to assess early outcomes of minimally invasive septal myectomy performed through a right anterior minithoracotomy.
  
  
  
  Between 2011 and 2014, 24 consecutive patients underwent isolated septal myectomy through a 4-5-cm right parasternal minithoracotomy. Perioperative clinical and echocardiographic outcomes in these patients were compared with those of a historical cohort of 26 consecutive patients who underwent isolated septal myectomy performed through a median sternotomy between 2002 and 2010.
  
  
  
  Age and sex distribution were similar between the groups. Median aortic cross-clamp time was 57 minutes in the minithoracotomy group vs 43 minutes in the sternotomy group (P = 0.149). There was no in-hospital mortality in either group. Intraoperative conversion to sternotomy was required in 1 patient. Postoperative permanent pacemaker implantation was required in 5 patients from each group (P = 0.999). Both groups demonstrated similar reductions in left ventricular outflow tract gradient and septal thickness. Residual obstructive systolic anterior motion of the mitral valve was observed in 2 patients (8%) in the minithoracotomy group and 1 patient (4%) in the sternotomy group (P = 0.602).
  
  
  
  This study demonstrates the feasibility of transaortic septal myectomy through a right minithoracotomy. Our early results suggest that this technique yields clinical and echocardiographic outcomes similar to those obtained with standard sternotomy.
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: Amine
authors.initials: A
authors.lastname: Mazine
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: Aly
authors.initials: A
authors.lastname: Ghoneim
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: Ismail
authors.initials: I
authors.lastname: Bouhout
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: William
authors.initials: W
authors.lastname: Fortin
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: Ilyes
authors.initials: I
authors.lastname: Berania
authors.affiliation: Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: Philippe L
authors.initials: PL
authors.lastname: L'Allier
authors.affiliation: Department of Cardiology, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada.
authors.forename: Patrick
authors.initials: P
authors.lastname: Garceau
authors.affiliation: Department of Cardiovascular Surgery, Montreal Heart Institute and Université de Montréal, Montréal, Québec, Canada. Electronic address: denis.bouchard@icm-mhi.org.
authors.forename: Denis
authors.initials: D
authors.lastname: Bouchard
mesh_terms: D000328:Adult; D000368:Aged; D002312:Cardiomyopathy, Hypertrophic / Q000601:surgery*; D015331:Cohort Studies; D017548:Echocardiography, Transesophageal; D005260:Female; D006346:Heart Septum / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D010138:Pacemaker, Artificial / Q000706:statistics & numerical data; D011183:Postoperative Complications; D056346:Sternotomy; D013908:Thoracotomy / Q000379:methods*; D014694:Ventricular Outflow Obstruction / Q000601:surgery