Transaortic septal myectomy at the time of aortic valve replacement for severe aortic stenosis: a case series of 55 cases.

Content Provider	Europe PMC
Author	Karapanagiotidis, Georgios Theodoros Anastasakis, Evangelos Nana, Chrysoula Gukop, Philemon Sylvester Zakkar, Mustafa Tossios, Paschalis Grosomanidis, Vasilios Sarridou, Despoina Krimiotis, Dimitrios Sarsam, Mazin Abdulla Ibrahim
Abstract	IntroductionSymptomatic aortic valve stenosis (AS) is associated with asymmetric basal septal hypertrophy (ABSH) in 10% of cases. In this cohort, it has been suggested that rectification of the left ventricular outflow tract obstruction (LVOTO) by concomitant septal myectomy (CSM) can improve the results of aortic valve replacement (AVR).ObjectiveThis study aims to present the technique of AVR with CSM for severe AS with ABSH and to determine the associated early and late post-operative outcomes.MethodsFifty-five patients were prospectively recruited to undergo AVR with CSM between 2011 and 2021 at two centres. The primary outcomes were mortality within 30 days, incidence of post-operative ventricular septal defects (VSD) and prosthetic valve sizing. The secondary outcomes were in-hospital complications, permanent pacemaker implantation (PPI), survival at 15 months and changes on transthoracic echocardiogram.ResultsPost-operative mortality was 1.8% and this figure was unchanged at 15-month follow-up. No patients developed a post-operative VSD. Intra-operatively, it was found that in 94.6% cases the direct valve sizing increased by one, when compared to the measurement made before CSM. The indexed effective orifice area (iEOA) was > 85 cm2/m2 in 96.4% and no patients had an iEOA ≤ 0.75 cm2/m2. Four patients (7.3%) required PPI due to complete atrioventricular block.ConclusionAVR with CSM is a simple technique that can be utilised in severe AS with ABSH. There does not appear to be an increase in mortality or incidence of iatrogenic VSDs. Importantly, CSM allows for the implantation of a larger aortic valve compared to measurements made before CSM.
Related Links	https://europepmc.org/backend/ptpmcrender.fcgi?accid=PMC11045907&blobtype=pdf
ISSN	09709134
Volume Number	40
DOI	10.1007/s12055-023-01661-x
PubMed Central reference number	PMC11045907
Issue Number	3
PubMed reference number	38681705
Journal	Indian Journal of Thoracic and Cardiovascular Surgery [Indian J Thorac Cardiovasc Surg]
e-ISSN	09737723
Language	English
Publisher	Springer Nature Singapore
Publisher Date	2023-12-20
Publisher Place	Singapore
Access Restriction	Open
Rights License	Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. © Crown 2023
Subject Keyword	Septal myectomy Aortic stenosis Aortic valve replacement
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine