Combined anterior mitral valve leaflet retention plasty and septal myectomy in patients with hypertrophic obstructive cardiomyopathy

• Published in: European journal of cardio-thoracic surgery Vol. 40; no. 6; pp. 1515 - 1520
• Main Authors: Nasseri, Boris A., Stamm, Christof, Siniawski, Henryk, Kukucka, Marian, Komoda, Takeshi, Delmo Walter, Eva M., Hetzer, Roland
• Format: Journal Article
• Language: English
• Published: Oxford Elsevier Science B.V 01.12.2011; Oxford University Press
• Subjects: Adult; Biological and medical sciences; Blood Pressure - physiology; Cardiology. Vascular system; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - physiopathology; Cardiomyopathy, Hypertrophic - surgery; Endocardial and cardiac valvular diseases; Epidemiologic Methods; Female; Heart; Heart Septum - surgery; Hemodynamics; Humans; Male; Medical sciences; Middle Aged; Mitral Valve - physiopathology; Mitral Valve - surgery; Mitral Valve Insufficiency - complications; Mitral Valve Insufficiency - physiopathology; Mitral Valve Insufficiency - surgery; Myocarditis. Cardiomyopathies; Pneumology; Reoperation - statistics & numerical data; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the heart; Treatment Outcome; Ventricular Outflow Obstruction - etiology; Ventricular Outflow Obstruction - physiopathology; Ventricular Outflow Obstruction - surgery; HOCM; Mitral regurgitation; Mitral valve reconstruction; SAM; Human; Reconstruction; Mitral valve; Anterior; Cardiovascular disease; Patient; Retention; Myocardial disease; Plasty; Treatment; Cardiac valvular disease; Surgery; Hypertrophic cardiomyopathy; Circulatory system; Cardiology; Myectomy; Pneumology
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/j.ejcts.2011.03.040

Abstract Objectives: Septal myectomy is the treatment of choice for patients with hypertrophic obstructive cardiomyopathy (HOCM) with significant left-ventricular outflow tract (LVOT) obstruction. In some HOCM patients, however, systolic anterior motion (SAM) of the anterior mitral leaflet significantly contributes to LVOT obstruction, resulting in mitral regurgitation and insufficient release of the obstruction after myectomy. We, therefore, developed a strategy of combined myectomy and anterior leaflet retention plasty (ALRP), and investigated its results in adult HOCM patients with manifest SAM. Methods: Subaortic septal myectomy and ALRP were performed in 25 adult HOCM patients with significant SAM, as assessed by echocardiography (mean age = 48.5 ± 15 years). All patients received cardiac catheterization and echocardiography evaluation prior to the operation, before discharge, and at follow-up. Follow-up ranged between 0.8 and 14 years (median = 2.5 years). Results: All patients survived the operation, and the Kaplan-Meier estimated survival was 100% at 1 year and 82 ± 6% at 5 years. Freedom from re-operation at 5 years was 83 ± 8%. The mean LVOT pressure gradient decreased from 84 ± 32 to 19 ± 11 mmHg postoperatively (p ≪ 0.001), and only two patients had mild residual or recurrent SAM at follow-up. Mitral regurgitation and New York Heart Association classification were also markedly improved at follow-up. Conclusions: Combined subaortic septal myectomy and ALRP is a safe and effective therapy in HOCM patients with significant SAM. ALRP can help prevent residual or recurrent LVOT obstruction and improves mitral regurgitation.