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

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

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, r...

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Bibliographic Details
Published in:Acta chirurgica belgica Vol. 112; no. 1; pp. 85 - 88
Main Authors: Sansone, F., Actis Dato, G.M., Zingarelli, E., Flocco, R., Punta, G., Forsennati, P.G., Parisi, F., Bardi, G., del Ponte, S., Casabona, R.
Format: Journal Article
Language:English
Published: Bruxelles Taylor & Francis 01-01-2012
Acta Medica Belgica
Subjects:
Adolescent
Adult
Aged
Biological and medical sciences
Cardiac Surgical Procedures - instrumentation
Cardiology. Vascular system
Cardiomyopathy, Hypertrophic - surgery
Child
Equipment Design
Female
General aspects
Heart
Heart Septum - surgery
Humans
Male
Medical sciences
Middle Aged
Myocarditis. Cardiomyopathies
Young Adult
Medicine
Treatment
Heart disease
Surgery
Hypertrophic cardiomyopathy
Cardiovascular disease
Surgical resection
Cutting tool
Myocardial disease
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Summary: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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ISSN:0001-5458
DOI:10.1080/00015458.2012.11680803