Experimental validation of extended access to the interventricular septum in the surgical treatment of hypertrophic cardiomyopathy

Background. Currently, there has been an increase in the number of reported cases of hypertrophic cardiomyopathy, probably due to improvements in diagnostic techniques, examination methods, and an increase in the total number of patients. The gold standard for surgical treatment remains open transaortic myectomy, which has a number of disadvantages, such as limited visualization, in some cases leading to the inability to perform radical resection of hypertrophied muscles. The need to expand the scope of resection, improve the quality of visualization, and reduce the frequency of disease recurrence determines the relevance of developing a new technique for accessing the interventricular septum.

Objective. To investigate the possibilities of new extended access to the interventricular septum with effective repair of the aortic and mitral valves in the surgical treatment of hypertrophic cardiomyopathy in an experimental setting.

Design and methods. From March 2017 to May 2023, two series of experiments have been conducted at the Center for Preclinical and Translational Research of the Almazov National Medical Research Centre to investigate extended access to the interventricular septum with repair of the aortic and mitral valves.

Results. The developed extended access to the interventricular septum demonstrated its effectiveness on experimental anatomic models. The possibility of effective repair of the aortic valve commissure and the anterior mitral valve leaflet after the extended access without a significant impact on the geometry of the fibrous annuli and the function of these valves has been proven.

Conclusion. The developed extended access allows for improved visualization of the interventricular septum in patients with a narrow fibrous ring of the aortic valve, mid-ventricular and apical forms of hypertrophic cardiomyopathy. Restoration of the valve apparatus (mitral and aortic valves) using the new access is possible and effective. Based on the results of this study it seems promising to conduct preclinical studies (in vivo on animals). And in the future — implementation in clinical practice in certain groups of patients.

1. Oleynikov VE, Rogoza AN, Averyanova EV, et al. The advantages of multi-day telemetric monitoring of an electrocardiogram in patients who have suffered a myocardial infarction. Cardiological Bulletin. 2024;19(2):39–46. (In Russ.). https://doi.org/10.17116/Cardiobulletin20241902139

2. Salari N, Morddarvanjoghi F, Abdolmaleki A, et al. The global prevalence of myocardial infarction: a systematic review and meta-analysis. BMC Cardiovasc Disord. 2023;23(1):206. https://doi.org/10.1186/s12872-023-03231-w

3. Scalise RM, Sarro RD, Caracciolo A, et al. Fibrosis after myocardial infarction: an overview on cellular processes, molecular pathways, clinical evaluation and prognostic value. Med Sci. 2021;9(1):16. https://doi.org/10.3390/medsci9010016

4. Leancă SA, Crișu D, Petriș AO, et al. Left ventricular remodeling after myocardial infarction: from physiopathology to treatment. Life. 2022;12(8):1111. https://doi.org/10.3390/life12081111

5. Vyas R, Changal KH, Bhuta S, et al. Impact of intramyocardial hemorrhage on clinical outcomes in ST-elevation myocardial infarction: a systematic review and meta-analysis. J Soc Cardiovasc Angiogr Interv. 2022;1(6):1100444. https://doi.org/10.1016/j.jscai.2022.100444

6. Peek N, Hindricks G, Akbarov A, Tijssen JG. Sudden cardiac death after myocardial infarction: individual participant data from pooled cohorts. Eur Heart J. 2024;45(43):4616–4626. https://doi.org/10.1093/eurheartj/ehae326

7. Rusak TV, Gelis LG, Miadzvedzeva AA, et al. Cardiac structural and functional changes in ischemia-reperfusion injury of myocardium. Eurasian heart journal. 2022;(3):74–82. (In Russ.) https://doi.org/10.38109/2225-1685-2022-3-74-82

8. Garcia MJ, Kwong RY, Scherrer-Crosbie M, et al. American heart association council on cardiovascular radiology and intervention and council on clinical cardiology. State of the art: imaging for myocardial viability: a scientific statement from the American Heart Association. Circ Cardiovasc Imaging. 2020;13(7):e000053. https://doi.org/10.1161/HCI.0000000000000053

9. Wang Y, Li Q, Tao B, et al. Fibroblasts in heart scar tissue directly regulate cardiac excitability and arrhythmogenesis. Science. 2023;381(6665):1480–1487. https://doi.org/10.1126/science.adh9925

10. Russian Society of Cardiology. Clinical practice guidelines for Acute ST-segment elevation myocardial infarction. Russian Journal of Cardiology. 2020;25(11):4103. (In Russ.) https://doi.org/10.15829/29/1560-4071-2020-4103.2020

11. Averyanova EV, Tonkoglaz AA, Chernova AA, et al. Complex multifactorial prediction model for life-threatening ventricular arrhythmias in patients with myocardial infarction. Cardiovascular Therapy and Prevention. 2025;24(1):4215. (In Russ.) https://doi.org/10.15829/1728-8800-2025-4215. EDN: OODLYB

12. Jáuregui B, Soto-Iglesias D, Penela D, et al. Cardiovascular magnetic resonance determinants of ventricular arrhythmic events after myocardial infarction. Europace. 2022;24(6):938– 947. https://doi.org/10.1093/europace/euab275

13. Dandel M, Javier MF, Javier Delmo EM, et al. Weaning from ventricular assist device support after recovery from left ventricular failure with or without secondary right ventricular failure. Cardiovasc Diagn Ther. 2021;11(1):226–242. https://doi.org/10.21037/cdt-20-288

14. Lebedev DS, Mikhailov EN, Neminuschiy NM, et al. Ventricular arrhythmias. Ventricular tachycardias and sudden cardiac death. 2020 Clinical guidelines. Russian Journal of Cardiology. 2021;26(7):4600. (In Russ.) https://doi.org/10.15829/1560-4071-2021-4600

15. Gyoten T, Amiya E, Kinoshita O, et al. Myocardial recovery evaluation from ventricular assist device in patients with dilated cardiomyopathy. ESC Heart Fail. 2022;9(4):2491–2499. https://doi.org/10.1002/ehf2.13951

16. Nikoo MH, Naeemi R, Moarefl A, Attar A. Global longitudinal strain for prediction of ventricular arrhythmia in patients with heart failure. ESC heart failure. 2020;7(5):2956–2961. https://doi.org/10.1002/ehf2.12910

17. Zamahina OV, Bunova SS, Usacheva EV, et al. Remodeling of the left ventricle of the heart depending on the autonomic status in patients with myocardial infarction. Modern problems of science and education. 2016;3:347–354. (In Russ). URL: https://science-education.ru/ru/article/view?id=24681 (Available from: 20.08.2025).