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Robotic Trans-Mitral Septal Myectomy and Papillary muscle reorientation for HOCM combined with or without Mitral valve repair: Technical aspects – How we do it
  • +3
  • Ashok Kumar CJ,
  • A. Marc Gillinov,
  • Nicholas Smedira,
  • Kevin Hodges,
  • Daniel Burns,
  • Per Wierup
Ashok Kumar CJ
Cleveland Clinic
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A. Marc Gillinov
Cleveland Clinic
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Nicholas Smedira
Cleveland Clinic
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Kevin Hodges
Cleveland Clinic
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Daniel Burns
Cleveland Clinic
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Per Wierup
Cleveland Clinic
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Peer review status:ACCEPTED

22 Jun 2020Submitted to Journal of Cardiac Surgery
22 Jun 2020Submission Checks Completed
22 Jun 2020Assigned to Editor
22 Jun 2020Reviewer(s) Assigned
25 Jun 2020Review(s) Completed, Editorial Evaluation Pending
25 Jun 2020Editorial Decision: Revise Minor
09 Jul 20201st Revision Received
20 Jul 2020Submission Checks Completed
20 Jul 2020Assigned to Editor
20 Jul 2020Reviewer(s) Assigned
22 Jul 2020Review(s) Completed, Editorial Evaluation Pending
22 Jul 2020Editorial Decision: Accept

Abstract

Hypertrophic obstructive cardiomyopathy (HOCM) is one of the more common genetic disorders. The pathophysiology and natural history of the disease have been well studied. Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the anterior mitral leaflet can result in sudden cardiac death, progressive heart failure and arrythmias. Surgical septal myectomy for HOCM is the standard of care and is routinely performed through a median sternotomy. Septal myectomy has also been performed using the trans-atrial, trans-mitral approach either directly or with robotic assistance. In cases with severe LVOT obstruction in the setting of only mild to moderate proximal septal hypertrophy, intrinsic problems with the mitral valve contribute. Typically, these are hyper-mobile papillary muscles and or excessive height of the anterior mitral leaflet. Combining septal myectomy with reorientation of hyper-mobile anteriorly positioned papillary muscles has shown to prevent SAM and thereby additionally decrease the sub-valvular aortic outflow obstruction. Our extensive experience in both septal myectomy and robotic mitral valve repair has given us a different perspective in approaching the primary mitral regurgitation in HOCM patients where a combined septal myectomy, papillary muscle reorientation and complex mitral valve repair has been safely performed using the less invasive robotic-assisted approach. Our objective here is to discuss the technical aspects of the procedure.