Recently, the team led by Yan Yang, Director of Department of Cardiovascular Surgery of the First Affiliated Hospital of Xi 'an Jiaotong University (XJTU), successfully performed thoracoscope-assisted Morrow surgery via small intercostal incision for a patient with hypertrophic obstructive cardiomyopathy. Different from conventional technique, the surgery was performed via the right intercostal approach using a 6-cm incision. According to our knowledge, this surgery has been carried out in few heart centers in China. This is the first case in northwest China, indicating that Department of Cardiovascular Surgery in our hospital has achieved novel technical breakthrough and taken a step forward in the field of minimally invasive cardiac therapy.
Two years ago, a male patient surnamed Liu (anonymous name) was transferred to Department of Cardiovascular Surgery of our hospital. ECG showed that the inner diameter of the left ventricular outflow tract became narrowed, the narrowest part was approximately 5 mm, the flow rate was 654 cm/s, and the pressure difference was 171 mmHg.
Professor Yan Yang led an expert team to carry out comprehensive analysis and repeated discussion, and boldly adopted "thoracoscope-assisted Morrow surgery via small intercostal incision".
Morrow surgery is the main surgical treatment for hypertrophic obstructive cardiomyopathy, which can treat the obstruction by resecting hypertrophic myocardial tissues. It is a highly demanding procedure, which is mainly completed via open surgery in the middle. Intraoperatively, repeated blockage should be carried out, and the incidence of complications, such as ventricular septal perforation and atrioventricular block, is relatively high. It is extremely difficult to complete the surgery using a small 5-6 cm incision.
Preoperatively, Department of Cardiovascular Surgery, Department of Anesthesiology and Perioperative Medicine and ECG Room conducted multiple rounds of consultation and assessment, and prepared explicit emergency plans for surgical details and potential surgical risk. At 14:30 pm on July 20, Professor Yan Yang began to perform the surgery as the chief surgeon, and fully cooperated with Department of Anesthesiology and Perioperative Medicine and ECG Room. The surgery was conducted through the second intercostal approach on the right side of sternum. The surgical field could be clearly exposed by flexibly manipulating the angle of thoracoscope, and the appropriate site was chosen. Wedge resection of ventricular septum under aortic valve was employed to precisely resect the obstructed myocardium, and aorta blockage was conducted only once during the surgery. The surgery endured for only 3 hours, intraoperative blood loss was 100 ml, and surgical incision was only 6 cm. Postoperative ultrasound showed that the stenosis of the left ventricular outflow tract was basically relieved, the left ventricular outflow tract diameter was enlarged from 5 mm to 25 mm during cardiac contraction, and the pressure difference was lowered from 171 mmHg to 12.9 mmHg. The function of cardiac contraction was restored to normal, and the patient was discharged at postoperative 1 week.
Thoracoscope-assisted Morrow surgery is a challenging procedure in two aspects. First, the surgical incision is small, the surgical field cannot be fully exposed, leaving limited space for the surgeon, which significantly increases surgical difficulty. Secondly, it is difficult to accurately determine the thickness and range of hypertrophic myocardial resection.
From "hypertrophic heart" to "healthy heart", Department of Cardiovascular Surgery has taken a different approach and innovatively applied minimally invasive technique in the treatment of complicated heart diseases, which not only mitigates surgical trauma, achieves clinical efficacy equivalent to open surgery, and guarantees the safety and health of patients.
