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ISMICS 2026 Annual Meeting
10 - 13 June, 2026 | Miami, Florida
D123
Combined Mitral Valve Surgery And Trans-aortic Septal Myectomy By Minimally Invasive Right Anterior Mini Thoracotomy
Poster Presenter
Authors
Abdulrahman ALJUAYLI, Abdullatif Abo Dan, Nebil Ajmi, Denis Bouchard
Affiliations
Part of Topic
Valve � Surgical Valves
Minimally Invasive Right Anterior Mini-Thoracotomy for
Combined Mitral Valve Surgery and Trans-Aortic Septal Myectomy:
Insights from a Single-Center Study
BACKGROUND
Hypertrophic obstructive cardiomyopathy (HOCM) can cause significant LVOT obstruction and can be associated with mitral valve abnormalities such as degenerative disease or SAM-related mitral regurgitation. In these patients, optimal treatment may require both septal myomectomy and mitral valve surgery. This study reviews our center’s experience with this combined minimally invasive approach
SPECIFIC OBJECTIVES
To evaluate the feasibility, perioperative outcomes, and early hemodynamic results of concomitant mitral valve surgery and trans‑aortic septal myectomy via a minimally invasive right anterior mini‑thoracotomy.
MATERIALS & METHODS
•Retrospective review of 17 patients (2014–2025) who underwent concomitant mitral valve surgery and trans-aortic septal myomectomy via a right anterior mini-thoracotomy.
•Mean age: 64.4 years, 70.6% female.
•Indications: symptomatic LVOT obstruction (mean rest gradient 50.4 ± 24.6 mmHg) plus mitral pathology (degenerative MR, SAM-related MR, rheumatic MS, mixed disease, iatrogenic MR).
•Procedures: 58.8% repairs (n=10), 41.2% replacements (n=7) — 5 mechanical, 2 bioprosthetic.
•Septal myomectomy and mitral surgery performed through the same intercostal space.
•Endpoints: perioperative outcomes, complications, 30-day mortality, postoperative rhythm, hemodynamics.
RESULTS
Operative Outcomes
•No 30-day mortality.
•CPB time: 84 ± 23 min; cross-clamp: 70 ± 17 min.
•ICU stay: 2.9 ± 2.8 days; hospital stay: 10.1 ± 4.9 days.
•Post-repair MV gradient: 4.7 mmHg (8 none–mild MR, 2 moderate).
•Post-replacement gradient: 4.9 mmHg; no PVL.
LVOT Gradient Reduction
•Pre-op LVOT rest gradient range: 20–96 mmHg.
•Post-op: 12 ≤20 mmHg, 4 = 20–40 mmHg, 1 residual SAM (MitraClip).
Rhythm & Complications
•Sinus rhythm at discharge: 12/17 (70.6%).
•Pacemaker: 4/17 (23.5%).
•Transfusions: 7 patients.
No infections or reoperations.
Conclusion
Minimally invasive right anterior mini-thoracotomy is a feasible and safe approach for combined mitral valve surgery and trans-aortic septal myectomy, demonstrating acceptable operative times, no early mortality, low morbidity, excellent mitral results, and significant LVOT gradient reduction. This technique provides a valuable alternative to sternotomy in selected patients requiring concomitant procedures.