Transapical septal myectomy in the beating heart via a minimally invasive approach: a feasibility study in swine
Transapical septal myectomy in the beating heart via a minimally invasive approach: a feasibility study in swine
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通过微创方法对跳动的心脏进行经心尖间隔肌切除术：猪的可行性研究
DOI：
10.1093/icvts/ivz249
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发表时间：
2020-02-01
影响因子：
--
通讯作者：
Wei, Xiang
中科院分区：
文献类型：
--
作者：
Fang, Jing;Wang, Rui;Wei, Xiang
目的：本研究的目的是建立一个原始的经心尖中隔肌切除术程序，可以在跳动的心脏通过微创方法治疗肥厚性梗阻性cardiomyopathy.METHODS：我们设计了一个原始的心内中隔切除装置进行非体外循环中隔肌切除术在猪。进行剑突下小切口开胸术以进入心尖。该切除装置通过心尖插入心脏的左心室流出道。右主动脉瓣尖下的基底前间隔心肌，确定使用经食管和经胸超声心动图的组合，然后切除和收集的device.Results：连续六次手术成功，准确地进行了使用定制的设备下超声心动图的指导。所有猪均存活，并表现正常，直至术后1周计划安乐死。从正常猪心切除300- 700 mg的间隔心肌。超声心动图和心电图显示切除后无异常。一个例外是第5只猪，重复切除后发生轻度主动脉瓣环返流。尸检表明，所有切除正确地位于右主动脉cusp.CONCLUSIONS的基础前间隔下的隔膜：我们的研究提供了第一个概念验证的证据，一种新的跳动的心脏经心尖间隔肌切除术的程序，这表明有前途的转化潜力治疗肥厚性梗阻性心肌病。这种手术可能会降低手术风险，改善预后，并减少进行传统手术肌切除术所需的专业知识。
OBJECTIVES: The aim of this study was to establish an original transapical septal myectomy procedure that can be performed in the beating heart via a minimally invasive approach for the treatment of hypertrophic obstructive cardiomyopathy.METHODS: We designed an original intracardiac septum resection device to conduct off-pump septal myectomy in swine. A subxiphoid minithoracotomy was performed to access the apex of the heart. This resection device was inserted into the left ventricular outflow tract of the heart via the apex. The basal anteroseptal myocardium beneath the right aortic cusp was identified using a combination of transoesophageal and transthoracic echocardiography and then resected and collected by the device.RESULTS: Six consecutive operations were successfully and accurately performed using the custom-made device under echocardiographic guidance. All pigs survived and appeared to be normal until planned euthanasia 1 week after operation. A 300-700mg portion of the septal myocardium was resected from the normal swine heart. Echocardiography and electrocardiogram revealed no abnormalities after resection. One exception was the fifth pig, in which mild annular regurgitation of the aortic valve occurred after repetitive resection. Postmortem necropsy demonstrated that all resections were correctly located at the basal anteroseptal septum beneath the right aortic cusp.CONCLUSIONS: Our study provides the first proof-of-concept evidence for a novel beating heart transapical septal myectomy procedure, which showed promising translational potential for the treatment of hypertrophic obstructive cardiomyopathy. This procedure would probably reduce operative risks and improve outcomes and reduce the demanding expertise required to perform conventional surgical myectomy.