Use of the novel virtual myectomy in guiding thoracoscopic myectomy for patients with hypertrophic obstructive cardiomyopathy

Abstract

Background

This study aimed to evaluate the efficacy of a novel virtual myectomy procedure in guiding thoracoscopic trans-mitral myectomy.

Methods and Results

Clinical data from 37 patients who underwent thoracoscopic trans-mitral septal myectomy guided by virtual myectomy between April 2019 and October 2021 were retrospectively analyzed. Enhanced cardiac CT images were imported into Mimics software to perform virtual myectomy. The short-axis two-chamber plane, perpendicular to the interventricular septum (IVS), was marked for each segment from the basal septum to the apex. IVS thickness was continuously measured at each marked segment, and a figurative digital model determined the resection extent. The cohort consisted of 22 women (59.46 %) with a mean age of 53.14 ± 13.62 years. No deaths or permanent pacemaker implantations occurred. Septal thickness decreased significantly from 20.49 ± 3.85 to 11.28 ± 2.53 mm (P < 0.001), resulting in a marked reduction in obstruction (90.84 ± 28.78 to 11.59 ± 11.06 mmHg, P < 0.001). Twelve patients (32.43 %) underwent mitral valve replacement. The virtual resection’s length, width, thickness, and volume showed strong positive correlations with the actual resection (R = 0.76–0.89). The virtual model’s septal thickness was moderately correlated with the actual resection volume (R = 0.51, P < 0.01).

Conclusions

Virtual myectomy effectively guided septal myectomy, with favorable outcomes in selected patients. This approach, combined with preoperative 3D simulation and printing, enables precise planning for complex cases.