[Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases].

Objective: To examine the short-term curative effect with minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure. Methods: The clinical data of 60 patients who underwent video-assisted thoracoscopic transaortic modified Morrow procedure from August 2021 to August 2022 at Department of Cardiovascular Surgery, Zhejiang Provincial People's Hospital were retrospectively analyzed. There were 31 males and 29 females, with the age (M (IQR)) of 54.0(22.3) years (range: 15 to 71 years). The echocardiography confirmed the diagnosis of moderate mitral regurgitation in 30 patients, and severe mitral regurgitation in 13 patients. Systolic anterior motion (SAM) was present preoperatively in 54 patients. All 60 patients underwent transaortic modified Morrow procedure through a right infra-axillary thoracotomy using femorofemoral cardiopulmonary bypass. Surgical procedures mainly included transverse aortic incision, exposure of left ventricular outflow tract (LVOT), septal myectomy, and correction of the abnormal mitral valve and subvalvular structures. Results: All 60 patients underwent the programmatic procedures successfully without conversion to full sternotomy. The cardiopulmonary bypass time was (142.0±32.1) minutes (range: 89 to 240 minutes), while the cross-clamp time was (95.0±23.5) minutes (range: 50 to 162 minutes). The patients had a postoperative peak LVOT gradient of 7.0 (5.0) mmHg (range: 0 to 38 mmHg) (1 mmHg=0.133 kPa). A total of 57 patients were extubated on the operating table. The drainage volume in the first 24 h was (175.9±57.0) ml (range: 60 to 327 ml). The length of intensive care unit stay was 21.0 (5.8)h (range: 8 to 120 h) and postoperative hospital stay was 8 (5) days (range: 5 to 19 days). The postoperative septal thickness was 11 (2) mm (range: 8 to 14 mm). All patients had no iatrogenic ventricular septal perforation or postoperative residual SAM. The patients were followed up for 4 (9) months (range: 1 to 15 months), and none of them needed cardiac surgery again due to valve dysfunction or increased peak LVOT gradient during follow-up. Conclusion: Using a video-assisted thoracoscopic transaortic modified Morrow procedure through a right infra-axillary minithoracotomy can provide good visualization of the LVOT and hypertrophic ventricular septum, ensure optimal exposure of the mitral valve in the presence of complex mitral subvalvular structures, so that allows satisfactory short-term surgical results.目的： 探讨胸腔镜辅助右腋下4 cm小切口经主动脉行改良Morrow手术的早期效果。 方法： 回顾性分析2021年8月至2022年8月在浙江省人民医院心脏大血管外科接受治疗的60例梗阻性肥厚型心肌病患者的临床资料。男性31例，女性29例，年龄［M（IQR）］54.0（22.3）岁（范围：15~71岁）。术前合并二尖瓣反流中度30例，重度13例。54例患者术前存在二尖瓣收缩期前向运动征。患者均接受胸腔镜辅助右侧腋下切口手术，经股动、静脉插管建立外周心肺转流，经主动脉横切口显露左心室流出道并完成室间隔肥厚心肌切除术，同时完成二尖瓣及瓣下异常结构的矫治。 结果： 全部患者顺利完成胸腔镜辅助改良Morrow手术，无中转开胸。心肺转流时间（142.0±32.1）min（范围：89~240 min），主动脉阻断时间（95.0±23.5）min（范围：50~162 min）。术后即刻左心室流出道压差峰值为7.0（5.0）mmHg（范围：0~38 mmHg）（1 mmHg=0.133 kPa）。57例患者在手术台清醒后拔管。术后24 h胸腔引流量为（175.9±57.0）ml（范围：60~327 ml）。ICU停留时间为21.0（5.8）h（范围：8~120 h）。术后住院时间为8（5）d（范围：5~19 d）。术后超声心动图复查室间隔厚度为11（2）mm（范围：8~14 mm）。所有患者无医源性室间隔穿孔或术后残留二尖瓣收缩期前向运动征。随访4（9）个月（范围：1~15个月），随访期间无瓣膜功能障碍或因左心室流出道压差峰值增加需要再次心脏手术者。 结论： 胸腔镜辅助右腋下小切口经主动脉入路可以很好地显露左心室流出道和室间隔，以及二尖瓣和瓣下异常结构，由此入路行改良Morrow手术治疗梗阻性肥厚型心肌病的早期效果良好。.