Long-Term Benefit of Myectomy and Anterior Mitral Leaflet Extension in Obstructive Hypertrophic Cardiomyopathy

Vriesendorp, Pieter A.; Schinkel, Arend F. L.; Soliman, Osama Ibrahim Ibrahim; Kofflard, Marcel; Jong, Peter L. de; Herwerden, Lex A. van; Cate, Folkert J. ten; Michels, Michelle

doi:10.1016/j.amjcard.2014.12.017

Cited by 70 publications

(61 citation statements)

References 27 publications

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“…Разными авторами были предложены различные методики клапаносохраняющих операций у пациентов с ГКМП, включая увеличение передней створки МК [12][13][14], ретенционные пластики [15,16], пликационные техники [17][18][19] и подклапанные вмешательства [4,7,19]. Выбор техники чаще всего хирург-зависимый, нежели универсальный, особенно в случае необходимости выполнения повторной окклюзии аорты.…”

Section: Discussionunclassified

Septal Myectomy With Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: Immediate Results

Афанасьев¹,

Богачев-Прокофьев²,

Железнев³

et al. 2018

Sibirskij medicinskij žurnal

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Aim. Surgical septal myectomy is a standard treatment option for patients with hypertrophic obstructive cardiomyopathy. Subvalvular abnormalities of the mitral valve may play an important role in residual left ventricular outflow tract obstruction. This study aimed to evaluate the surgical outcomes of septal myectomy with subvalvular interventions.Material and Methods. Between July, 2015 and December, 2016, 40 eligible patients underwent septal myectomy with subvalvular intervention. The peak gradient was 92.3±16.9 mm Hg. The mean septum thickness was 26.8±4.5 mm. Moderate or severe systolic anterior motion syndrome-mediated mitral regurgitation was observed in all patients.Results. There was no residual mitral regurgitation. Residual systolic anterior motion syndrome was observed in 5%. The postoperative gradient was 8.7±4.5 mm Hg. At 12-month follow-up, all patients were alive. According to the New York Heart Association (NYHA) classification, 87.5 and 12.5% of patients had NYHA functional classes I and II, respectively. The prevalence rate of residual mitral regurgitation was 10%.Conclusions. Concomitant subvalvular intervention during septal myectomy effectively eliminated left ventricular outflow tract obstruction and provided high freedom from residual mitral regurgitation one year after surgery.

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Section: Discussionunclassified

Septal Myectomy With Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: Immediate Results

Афанасьев¹,

Богачев-Прокофьев²,

Железнев³

et al. 2018

Sibirskij medicinskij žurnal

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“…As the methods of cardiac imaging developed, enabling better understanding of the pathological mechanism of dynamic LVOT gradient elevation and the causes of the often concomitant MI, the dominant role of the Venturi effect was called into question [2]. Some large centers treating HOCM patients have proposed to employ more extensive myectomy with papillary muscle mobilization [5, 11–14]; others postulate the performance of concurrent mitral valvuloplasty [11, 12, 15, 16]. The long-term results of both strategies are equally satisfactory.…”

Section: Discussionmentioning

confidence: 99%

Extended myectomy in the treatment of patients with hypertrophic obstructive cardiomyopathy

Kuć

Kołsut

Różański

et al. 2016

kitp

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IntroductionPartial resection of the septal muscle is a well-established and effective method of surgical treatment for patients with hypertrophic obstructive cardiomyopathy (HOCM). The procedure is characterized by a low operative mortality rate and long-term clinical improvement that has been confirmed in numerous publications. Mitral insufficiency in patients with HOCM is mostly functional due to the effect of systolic anterior motion (SAM).AimTo present the early results of surgical treatment provided to HOCM patients and to compare the effectiveness of two surgical procedures: isolated myectomy and myectomy combined with mitral valve replacement.Material and methodsThe study analyzed a group of 49 patients (20 women) with HOCM who underwent surgical treatment between 2012 and 2015. Isolated myectomy was performed in 67.25% (n = 33) of patients, myectomy combined with mitral valve replacement in 30.61% (n = 15), and 1 (2.04%) patient underwent myectomy combined with mitral valvuloplasty (papillary muscle repositioning).ResultsA greater reduction of the left ventricular outflow tract (LVOT) gradient was observed in the population with concomitant mitral valve replacement in comparison to patients after isolated myectomy; the difference was statistically significant (p = 0.020). No significant correlation was observed between residual SAM and the grade of mitral regurgitation (p = 0.699) or between residual SAM and the LVOT gradient (p = 0.280).ConclusionsSurgical myectomy is a well-established, effective method of reducing increased LVOT gradients in patients with HOCM. Additional mitral valve replacement may be associated with greater reductions of the LVOT gradient in the early postoperative period. Valve replacement should be considered in patients with concomitant mitral valve degeneration and patients with narrowed left ventricular cavities.

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“…Surgical myectomy remains the first-line intervention for obstructive HCM with drug-refractory symptoms because of its established safety and effectiveness [1]. Abnormal mitral valve anatomy often contributes to LVOT obstruction, and several surgical series have shown that plication or extension of the anterior mitral valve leaflet resulted in significant improvements in symptoms, LVOT gradient, and degree of mitral regurgitation [24,25]. Alternatively, a recent observational study has confirmed the comparable outcome with alcohol septal ablation relative to surgical myectomy at a high volume center, but residual outflow tract gradient >10 mm Hg was associated with lower overall mortality [26].…”

Section: Therapeuticsmentioning

confidence: 99%

Hypertrophic Cardiomyopathy: New Evidence Since the 2011 American Cardiology of Cardiology Foundation and American Heart Association Guideline

Fraiche

Wang

2016

Curr Cardiol Rep

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Since publication of the 2011 American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) Guideline for the diagnosis and treatment of hypertrophic cardiomyopathy (HCM), more recent studies offer greater insights about this condition. With increased recognition of the role of sarcomere protein mutations and myocardial structural abnormalities in the pathophysiology of this disease, new evidence offers potential improvements for the management of patients with HCM. In this review of studies published since 2011, we highlight several studies that may impact diagnostic considerations, risk stratification, and treatment of symptoms in HCM.

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Long-Term Benefit of Myectomy and Anterior Mitral Leaflet Extension in Obstructive Hypertrophic Cardiomyopathy

Cited by 70 publications

References 27 publications

Septal Myectomy With Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: Immediate Results

Septal Myectomy With Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: Immediate Results

Extended myectomy in the treatment of patients with hypertrophic obstructive cardiomyopathy

Hypertrophic Cardiomyopathy: New Evidence Since the 2011 American Cardiology of Cardiology Foundation and American Heart Association Guideline

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