The Actis-Gouge: a Simple Cutting Tool for Proper Muscular Resection in Hypertrophic Cardiomyopathy

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Abstract

Background:

Surgical treatment of hypertrophic cardiomyopathy (HC) may be challenging for the risk of surgical complications or insufficient resection. We present our cutting tool to perform proper muscular resection in HC.

Material and methods:

Ten patients (5 males, mean age 43,1 ± 19,6 years, range 9-70 years) were operated on for HC using this semicircular cutting device. Combined procedures were: mitral valve repair (n = 1), mitral valve replacement (n = 2), right ventricular myectomy (n = 1), aortic valve replacement (n = 1), mitral and aortic replacement (n = 1).

Results:

There was one early death. All the surviving patients are alive over a variable follow up from 2 to 8 years, with consistent reduction of symptoms: in fact, no patient had residual angina with significant reduction of the NYHA class from 3,2 ± 0,6 to 1,3 ± 0,5 postoperatively (p < 0,05). Muscular resection was effective with significant reduction of sub-valvular gradient from 84.5 + 33,4 mmHg to 14,1 ± 17,6 mmHg (p < 0,05) without complications such as complete atrio-ventricular block or ventricular septal defects.

Conclusion:

Our semicircular myotome is an effective tool to perform a safe myectomy and it avoids surgical complications such as atrio-ventricular blocks or sub-valvular injuries. Our experience suggests that this cutting tool offers a reproducible method for muscular resection and it shows appreciable effects in the reduction of sub-valvular gradient with promising results in terms of morbidity and mortality.

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