Myectomy with mitral valve repair versus replacement in adult patients with hypertrophic obstructive cardiomyopathy: a systematic review and meta-analysis

Abstract

We evaluated the differences in mitral valve (MV) plasty (MVP) and MV replacement (MVR) with respect to death, postoperative MV dysfunction, reoperation rates and thromboembolic events (DFRE) in patients with hypertrophic obstructive cardiomyopathy and systolic anterior motion of the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, searching PubMed, Cochrane library and ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM & MR after MVP/MVR. We used a risk of bias assessment tool for non-randomized studies, and analyses were performed using Cochrane Review Manager 5.3.5 for I2 statistics, funnel plots and forest plot and the generic inverse variance method for hazard ratios (HRs). We developed qualitative and quantitative syntheses of 35 and 23 studies, respectively, including levels of evidence of ½/3/4/5 = 3/1/11/11/9 and ½/3/4/5 = 0/1/11/11/0, respectively, from January 1980 to August 2017. A statistically significant difference between MVP and MVR favoured MVP for the prevention of DFRE in patients with HOCM & MR, on the basis of a significant reduction of the HR for DFRE: HR = 0.68 (0.57, 0.82), I2 = 68% (P = 0.002). The findings were as follows: (i) MVP should be the first-line treatment in patients with HOCM & MR (accuracy LEVEL A) and (ii) MVR may be harmful if it is used as the first-line treatment (accuracy LEVEL A).

Anterior mitral leaflet length and mitral annulus diameter impact the echocardiographic outcome after isolated myectomy

“…Variety of surgical strategies, encompassing elongation as well as shortening of anterior mitral leaflet derives additional ambiguity in decision making. Mitral valve replacement is currently known as harmful and connected with inferior long-term prognosis, and numerous articles support this opinion [3, 4]. The mechanisms of dynamic LVOT obstruction are well known, it has been sufficiently proven that elongated AML contribute to dynamic increase of LVOT gradient among patients suffering from HCM [5, 6].…”

Surgical treatment of patients with obstructive hypertrophic cardiomyopathy

“…Согласно данным литературы [9], пластика митрального клапана предпочтительнее имплантации протеза при хирургическом лечении обструктивной ГКМП. В недавно опубликованном мета анализе, сравнивавшем пластику и протезирование митрального клапана при коррекции ГКМП, показана лучшая 2-летняя послеоперационная выживаемость у больных после пластики митрального клапана (87,2±4,9% против 96,7±3,3%; р=0,034).…”

2020 Clinical practice guidelines for Hypertrophic cardiomyopathy

“…Определяющим фактором для достижения хороших результатов СМЭ/РМЭ и САА является опыт Центров, который должен измеряться более чем 50 процедурами, выполняемыми в год, и более чем 20 процедурами, выполняемыми хирургом или интервенционным кардиологом. Редукция МЖП должна выполняться опытным специалистом, работающим в мультидисциплинарной команде экспертов в лечении ГКМП [3,4,106,213,320,321,[378][379][380][381][382][383][384][385][386].…”