Surgical septal reduction therapy in children and adolescents: Transapical beating-heart approach is simple, safe, and effective

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Abstract Submission 

Xiang Wei (1), Yue Chen (2), Jing Fang (3), Yani Liu (4), Song Wan (5)

(1) Tongji Hospital, Wuhan, Hubei, (2) Tongji hospital, Wuhan, Hubei, (3) Tongji Hospital, wuhan, China, (4) [email protected], Wuhan, Hubei, (5) Huazhong University of Science and Technology, Wuhan, Hubei

*Xiang Wei    -  Contact Me
Tongji Hospital

Yue Chen    -  Contact Me
Tongji hospital

Jing Fang    -  Contact Me
Tongji Hospital

Yani Liu    -  Contact Me
[email protected]

*Song Wan    -  Contact Me
Huazhong University of Science and Technology

*Xiang Wei    -  Contact Me
Tongji Hospital

Background Surgical septal myectomy is considered the primary therapeutic strategy for obstructive hypertrophic cardiomyopathy (oHCM) in majority of patients who were unresponsive to medical therapy. However, limited data on children and adolescents is currently available, largely due to the technical challenges associated with the operation in this particular age group.
Methods From May 2018 to July 2024, 36 patients with oHCM aged 5 to 18 years underwent conventional transaortic septal myectomy (TASM, n=5) or a novel transapical beating-heart septal myectomy (TA-BSM, n=31). All patients have completed clinical and multimodality imaging evaluations before operation and at 3-month follow up.
Results The age of patients was 13.8±2.9 (Mean ± SD) years and 9 of them (25%) were female. The median preoperative left ventricular outflow tract gradient (LVOTG) was 69 (IQR: 36-85) mmHg. About 67% of the patients had more than moderate mitral regurgitation (MR, TASM n=3, TA-BSM n=21). Both approaches demonstrated equivalent efficacy for resolution of LVOT obstruction, with a median postoperative LVOTG of 24 and 13 mmHg (p=0.14) in the TASM and TA-BSM groups, respectively. At 3-month follow up, the degree of MR was mild in majority of patients in both group (Table), whereas all patients showed improved NYHA class and quality of life. Compared to those in the TASM group, patients in the TA-BSM group experienced shorter operative time, shorter duration of postoperative mechanical ventilation, and shorter ICU stay (Table). The median weight of resected myocardium was 4.9 g in the TASM group and 6.7 g in the TA-BSM group (p<0.01). There was no in-hospital death, septal perforation, and pacemaker implantation in this cohort. One patient converted to urgent thoracoscopic mitral repair due to mitral chordae tendineae fracture during TA-BSM, and showed normal cardiac and valvular function upon 3-month follow-up.
Conclusion TA-BSM is a simple, safe, and effective septal reduction treatment for children and adolescents with oHCM. Compared with TASM, reduced surgical trauma led to quicker postoperative rehabilitation and recovery in the TA-BSM group. Moreover, the TA-BSM approach helps to overcome many challenges posed by the narrowed exposure with related difficulties in children and adolescents during conventional septal myectomy.

Left ventricular outflow tract obstruction