Early and medium-term outcomes of Alfieri mitral valve repair in the management of systolic anterior motion during septal myectomy

Collis, Richard; Watkinson, Oliver; Pantazis, Antonis; Esteban, Maria Teresa Tome; Elliott, Perry; McGregor, Christopher G.A.

doi:10.1111/jocs.13239

Cited by 12 publications

(12 citation statements)

References 20 publications

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“…A study by Shah and associates 11 focused on transaortic EE repair in 24 patients with HOCM with short (2.4 AE 2.5 months) follow-up data. Collis and colleagues 12 described a series of 11 patients who underwent transatrial EE repair to prevent (n ¼ 7) or treat (n ¼ 4) SAM at the time of septal myectomy. At a median follow-up of 6.6 years, there was a sustained improvement in New York Heart Association class and reduction in MR grade and resting LVOT gradient.…”

Section: Commentmentioning

confidence: 99%

“…A minority of HOCM patients may present with MR due to organic MV anomalies such as leaflet prolapse, chordal rupture, leaflet cleft, and fibrosis, which need to be addressed. 10 Few studies have assessed the role of the EE in this specific setting, [11][12][13] and most of them are limited by short follow-up and only early echocardiographic data. The Accepted for publication Mar 25, 2020.…”

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confidence: 99%

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Edge-to-Edge Mitral Repair Associated With Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy

Lapenna

Nisi

Ruggeri

et al. 2020

The Annals of Thoracic Surgery

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Background. To assess the long-term clinical and echocardiographic outcomes of the edge-to-edge mitral repair added to septal myectomy in patients with mitral regurgitation (MR) and hypertrophic obstructive cardiomyopathy.Methods. This is a single-center study of 26 patients with hypertrophic obstructive cardiomyopathy (septal thickness 17 ± 3 mm, resting left ventricular outflow tract gradient 63 ± 20 mm Hg, MR ‡ 2D/4D) who underwent an EE mitral procedure combined with ventricular septal myectomy. The EE procedure was used to treat MR due to systolic anterior motion in 19 patients (73%) and to posterior leaflet prolapse/flail in 7 (27%).Results. Hospital mortality was 4%. Follow-up was 100% complete (median 6.5 years; interquartile range, 2.7 to 9). Freedom from cardiac death was 88% ± 8.4% at 8 years. The 8-year cumulative incidence function of reoperation with death as competing risk was 7.7% ± 5.2%. At 8 years, the cumulative incidence function of recurrence of MR 3D or greater with death as competing risk was 7.9% ± 5.3%. Residual MR at discharge

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Section: Commentmentioning

confidence: 99%

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confidence: 99%

Edge-to-Edge Mitral Repair Associated With Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy

Lapenna

Nisi

Ruggeri

et al. 2020

The Annals of Thoracic Surgery

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“…Regarding the manoeuvre involving the leaflet, when the anterior leaflet is elongated by more than 30 mm, plication can shorten the leaflet length by 2-5 mm [2,3]. The edge-to-edge technique is an option for manoeuvring the mitral leaflet [4,5]. Currently, this procedure can also be performed on a beating heart [6].…”

Section: Discussionmentioning

confidence: 99%

Trapezoidal resection of an elongated anterior mitral leaflet and Alfieri stitch in hypertrophic cardiomyopathy

Nakajima

Tokunaga

Hayashi

et al. 2020

J Cardiothorac Surg

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Background In individuals with hypertrophic obstructive cardiomyopathy, elongated anterior mitral leaflets are commonly associated with systolic anterior motion. In patients with mild septal hypertrophy, a myectomy is considered insufficient to relieve systolic anterior motion and left ventricular outflow tract obstruction. Case presentation In the patient, who had relatively mild septal hypertrophy, the section of the anterior leaflet protruding into the left ventricular outflow tract was resected, concomitant with septal myectomy and the relocation of the papillary muscles. An edge-to-edge stitch was placed at the uppermost segment of the coaptation zone. Using these manoeuvres, systolic anterior motion, left ventricular outflow tract obstruction and mitral regurgitation were successfully resolved postoperatively. Conclusions We describe a surgical technique with an edge-to-edge suture for the resection of an elongated anterior mitral leaflet. In combination with septal myectomy and relocation of the papillary muscles, this technique is a simple and viable option, especially when septal hypertrophy is not severe.

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“…Many studies have validated the safety and efficacy of concomitant surgical reduction of MR with SM [ 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 ]. Given the inherent long-term effects of MVR (anticoagulation with a prosthetic valve, short life of a tissue valve), MVr may be favorable when possible.…”

Section: The Mitral Valvementioning

confidence: 99%

Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review

Lebowitz

Kowalewski

Raffa

et al. 2022

JCM

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Background: Hypertrophic obstructive cardiomyopathy (HOCM) is a heterogeneous disease with different clinical presentations, albeit producing similar dismal long-term outcomes if left untreated. Several approaches are available for the treatment of HOCM; e.g., alcohol septal ablation (ASA) and surgical myectomy (SM). The objectives of the current review were to (1) discuss the place of the standard invasive treatment modalities (ASA and SM) for HOCM; (2) summarize and compare novel techniques for the management of HOCM; (3) analyze current guidelines addressing HOCM management; and (4) offer suggestions for the treatment of complex HOCM presentations. Methods: We searched the literature and attempted to gather the most relevant and impactful available evidence on ASA, SM, and other invasive means of treatment of HOCM. The literature search yielded thousands of results, and 103 significant publications were ultimately included. Results: We critically analyzed available guidelines and provided context in the setting of patient selection for standard and novel treatment modalities. This review offers the most comprehensive analysis to-date of available invasive treatments for HOCM. These include the standard treatments, SM and ASA, as well as novel treatments such as dual-chamber pacing and radiofrequency catheter ablation. We also account for complex pathoanatomic presentations and current guidelines to offer suggestions for tailored care of patients with HOCM. Finally, we consider promising future therapies for HOCM. Conclusions: HOCM is a heterogeneous disease associated with poor outcomes if left untreated. Several strategies for treatment of HOCM are available but patient selection for the procedure is crucial.

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Early and medium-term outcomes of Alfieri mitral valve repair in the management of systolic anterior motion during septal myectomy

Abstract: The Alfieri repair, as adjunctive therapy, for the prevention or treatment of SAM at the time of SM demonstrates satisfactory early and medium-term clinical and echocardiographic outcomes supporting the ongoing utility of this approach.

Cited by 12 publications

References 20 publications

Edge-to-Edge Mitral Repair Associated With Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy

Edge-to-Edge Mitral Repair Associated With Septal Myectomy in Hypertrophic Obstructive Cardiomyopathy

Trapezoidal resection of an elongated anterior mitral leaflet and Alfieri stitch in hypertrophic cardiomyopathy

Review of Contemporary Invasive Treatment Approaches and Critical Appraisal of Guidelines on Hypertrophic Obstructive Cardiomyopathy: State-of-the-Art Review

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