Pitsis TE Transaortic Myectomy .mov (1.77 GB)
Download fileTotally Endoscopic Transaortic Septal Myectomy for Hypertrophic Cardiomyopathy
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posted on 2021-02-03, 15:38 authored by Antonios Pitsis, Nikolaos Tsotsolis, Nikolaos Nikoloudakis, Timotheos Kelpis, Vassilios Economopoulos, Georgios EfthimiadisThis video demonstrates a totally endoscopic transaortic extended septal
myectomy for obstructive hypertrophic cardiomyopathy in an 81-year-old
woman who was heavily symptomatic with class 3 shortness of breath. The
LVOT peak gradient was measured 132 mm Hg on TOE. The authors used a
totally endoscopic approach through a 3 cm, 2nd intercostal space (ICS),
right parasternal working incision, a 10 mm port for the 3D 30-degree
endoscope in the same ICS, and two stab wounds, one for the Chitwood
clamp in the 1st ICS and one for the atrial vent in the 5th ICS anterior
axillary line. This set up was the same with the one described by this
group previously on CTSNet and elsewhere for totally endoscopic aortic
valve surgery and totally endoscopic transaortic mitral valve repair
(1-4). The authors used a metal net to spread and protect the normal
aortic valve leaflets and four traction sutures to retract the basal
septum. The myectomy was performed according to the principles presented
by the Mayo Clinic group (5). Postoperative TOE revealed a widely open
LVOT with a peak gradient of 11.2 mm Hg. The patient had an uneventful
recovery and remains entirely asymptomatic six months postoperatively.
References
- Pitsis A, Tsotsolis N, Nikoloudakis N, Kelpis T, Economopoulos V, Keremidis I. Totally Endoscopic Aortic Valve Replacement With a Trifecta GT Bovine Pericardial Valve. CTSNet. August 2019. doi:10.25373/ctsnet.9587900.
- Pitsis A, Tsotsolis N, Nikoloudakis N, Kelpis T, Economopoulos V, Keremidis I, et al.. Totally Endoscopic Aortic Valve Replacement Using an Automated Annular Suturing Device. CTSNet. March 2020. doi:10.25373/ctsnet.12024627
- Pitsis A, Tsotsolis N, Nikoloudakis N, Keremidis I, Boudoulas H, Boudoulas KD. Totally Endoscopic Aortic Valve Replacement and Transaortic Mitral Valve Repair. CTSNet. February 2020. doi:10.25373/ctsnet.11689443.
- Pitsis A, Boudoulas C, Boudoulas KD. Operative steps of totally endoscopic aortic valve replacement, Interact Cardiovasc Thorac Surg. September 2020;31(3):424.
- Kotkar KD, Said SM, Dearani JA, Schaff HV. Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience. Ann Cardiothorac Surg. 2017;6(4):329-336.