With a long history behind, even after 6 decades, the septal #myectomy stood the test of time and continues to be recommended as first-line/mainstay primary treatment option for highly symptomatic drug-refractory patients with HCM to immediately and permanently abolish mechanical obstruction to LV/left ventricle outflow.
From the planning of the intervention to surgery itself, more than other cardiovascular pathologies, the hypertrophic obstructive cardiomyopathy/#hocm #surgery is personalized par excellence.
At the European Cardiomyopathy Center, the surgical team coordinated by Prof. Dr. Lucian Dorobantu performs not only a the one-piece-myectomy, but a technique of the LV/left ventricle reshaping with the best outcomes in terms of relieving symptoms and reversing progressive HF/heart failure caused by outflow obstruction.
In times and steps, the surgical team acts as one under the supervision of Professor Lucian Dorobantu, HOCM Senior specialized surgeon:
- In the pre-operation time, it is elaborated the planning calculating the dimensions of this unique piece (length, width, thickness), dimensions meant to perfectly match with the scripted data obtained from the transthoracic and transesophageal echocardiography, and from the cardiac MRI.
- We are rebuilding the whole narrowed ejection tract of the heart muscle, the tunnel through which exits the blood performing a personalized surgery. We aim to enlarge the ejection tract, “digging a new one”, through which the blood can flow, without any obstruction.
- The careful mobilization of the papillary muscles and mitral valves commissures are the first steps of the procedure, and the papillary muscles are brought in the center of the left ventricle.
- The one piece myectomy is performed respecting the exact measures previously calculated, performing a shallow myectomy exactly 1/3 of the septal thickness, avoiding catastrophic complications like ventricular septal defect.
- Resection of fibrotic secondary chordae moves the MV apparatus away from the outflow tract and enlarges the outflow area independently of septal thickness, facilitating septal myectomy by reducing the need for a deep muscular excision.
- The way out from the left ventricle is rebuilt pushing out of this “tunnel” the mitral valve and reconfiguring its way, in order to give back its functionality.
- We are looking to remodeling the mitral valve, which during the process becomes insufficient by additional transaortic mitral valve repair procedures like plicatures, etc. The main goal: in over 98% of the cases we manage to preserve the mitral valve which is extremely important for the patient and for the quality of life on long term.
Prof. Dr. Lucian Dorobantu explains: “Equally we have managed to standardize the HOCM surgery as we personalize the method in a disease that is not standard at all, on a contrary given the heterogeneity of the cases. Our technique stood the test of time as well, one-piece-myectomy offering patients some of the most striking clinical benefits achievable in the heart surgery by relieving symptoms and returning to an unrestricted normal lifestyle.”
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