Key result
Septal myectomy using 3D-printed models is linked to a ~91% reduction in resting LVOT gradient.
Why the study?
Completeness of septal myectomy in HOCM surgery is key, but planning relies on echocardiography and new visualization techniques are needed to monitor myectomy quality.
Does optimal septal myectomy guided by 3-dimensional printed models improve surgical outcomes and echocardiographic parameters in patients with HOCM?
Cohort (n=30)
No
Does optimal septal myectomy guided by 3-dimensional printed models improve surgical outcomes and echocardiographic parameters in patients with HOCM?
Absolute Event Rate: 7.1% vs 81.3%
p-value: p=< 0.001
The use of 3-dimensional printed models to guide septal myectomy in HOCM patients is feasible and results in significant improvements in left ventricular gradients and dimensions.
3D models may aid myectomy planning in low-volume HOCM centers; leaves open whether outcomes improve versus echocardiography alone.
Introduction: The completeness of septal myectomy (SM) is the key to surgery of hypertrophic obstructive cardiomyopathy (HOCM), but its planning is still based on echocardiographic findings.The need to perform radical SM requires the development of new cardio-visualisation techniques for monitoring myectomy quality.Aim: To improve results in centres treating few patients with HOCM using a new method of optimal SM with the help of 3-dimensional models to achieve an 'ideal' interventricular septum (IVS) thickness of 10-11 mm.Material and methods: Between 2017 and 2018, 30 patients underwent optimal SM after computed tomography angiography, creation of a virtual 3-dimensional model of the IVS, computer-aided mapping, virtual SM and 3-dimensional printing of models of the 'ideal' IVS and the fragment to be removed.Results: Initial isolated extended SM (n = 29, 97%) was effective in 23/29 (79%) patients.Four non-fatal complications were observed.A permanent pacemaker was implanted in three patients.No patients required mitral valve replacement.The mean postoperative left ventricle (LV) resting systolic gradient was 7.5 ±4.4 mm Hg, and at the latest follow-up this value was 7.1 ±4.2 mm Hg.The average weight of the excised myocardium was 12.0 g (range: 5.8-22.5 g).At follow-up both volumetric and dimensional LV echocardiography parameters increased compared with preoperative values (p ≤ 0.007).Conclusions: The proposed optimal SM provides intraoperative monitoring of the shape and volume of the myocardium resected to achieve the 'ideal' IVS, true radicality and an increase in the volumetric and dimensional parameters of the LV.
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Andrushchuk et al. (2019) conducted a cohort in Hypertrophic obstructive cardiomyopathy (n=30). Optimal septal myectomy using 3-dimensional printed models vs. Preoperative baseline was evaluated on Peak systolic gradient in obstruction area (p=< 0.001). Optimal septal myectomy using 3-dimensional printed models significantly reduced the mean resting peak left ventricular outflow tract gradient from 81.3 mm Hg to 7.1 mm Hg.
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