Transapical Beating-Heart Septal Myectomy in Patients with Apical Hypertrophic Cardiomyopathy: How I Do It

J. Fang¹, S. Wan¹, X. Wei^2
1Department of Cardiovascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei ²Tongji Hospital affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei

Please explain the educational or technical point that this video addresses.: The transapical beating-heart septal myectomy (TA-BSM) procedure was performed based on the beating-heart myectomy device (BMD). Preoperative gastrointestinal preparation is essential to ensure the definition of TEE image. Before operation, TEE was performed to evaluate the morphology, hypertrophy zone, and obstruction, which was used for the determination of final scheme. Briefly, operation is performed through a mini-thoracotomy to expose left ventricular apex and double purse string was performed at the avascular area. After heparinization, a manometric catheter was inserted into left ventricle, and the pulse pressure was persistently recorded via moving the catheter from subaortic to apex zone. After dilation of the entrance, the device (BMD) was inserted into the left ventricle to incise the hypertrophic myocardium, and the detailed steps were described previously. After resection, the pressure of the whole LV chamber was measured to ensure the relief of apical obstruction via the comparison of peripheral artery pressure. It is necessary for the appearance of cavities in apical zone to make sure the relief of apical obliteration. Finally, the apical puncture was closed using purse strings with Teflon felt. Apical ventricular aneurysm was not dealt with double-patch sandwich technique, and was treated with one or two surgical sutures in the aneurysm after tightening the purse strings.

Please provide a 250 word summary of the surgical video being submitted.: With the assistance of BMD, transapical basal septal myectomy (TA-BSM) emerges as a secure and efficient surgical intervention for individuals affected by ApHCM. The device can be precisely positioned along the apical ventricular septum, facilitating unobstructed operative field visibility for surgeons. Additionally, intraoperative echocardiography in TA-BSM acts as a guiding tool for pinpointing the target position, ensuring meticulous resections. Real-time monitoring of cardiac activity aids in assessing surgical outcomes, reducing the requisite skill and experience levels for the surgical team. Furthermore, multiple resections via BMD elevate left ventricular volume, alleviate systolic apical occlusion and mitigate a range of complications, thereby enhancing mid-term symptomatic relief. In comparison to traditional apical myectomy, TA-BSM demonstrates diminished surgical risks and trauma while offering enhanced operability for surgeons. The widespread adoption of TA-BSM stands to benefit a larger cohort of ApHCM patients, although extended follow-up periods and broader sample sizes are essential for comprehensive evaluation of its therapeutic efficacy.