Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel

Maron, Barry J.; Dearani, Joseph A.; Smedira, Nicholas G.; Schaff, Hartzell V.; Wang, Shuiyun; Rastegar, Hassan; Ralph-Edwards, Anthony; Ferrazzi, Paolo; Swistel, Daniel G.; Shemin, Richard J.; Quintana, Eduard; Bannon, Paul G.; Shekar, Prem; Desai, Milind Y.; Roberts, William C.; Lever, Harry M.; Adler, Arnon; Rakowski, Harry; Spirito, Paolo; Nishimura, Rick A.; Ommen, Steve R.; Sherrid, Mark V.; Rowin, Ethan J.; Maron, Martin S.

doi:10.1016/j.amjcard.2022.06.007

Cited by 34 publications

(24 citation statements)

References 149 publications

(325 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…3,65,66,[82][83][84][85][86][87] Surgical AF ablation AF is common in obstructive HCM with heart failure, and episodes often contribute significantly to symptom burden. 21,[69][70][71]97 In this patient subgroup, referral for surgical septal myectomy provides the opportunity to treat both heart failure symptoms by pertinently abolishing the outflow gradient (and associated mitral regurgitation), but also control AF with adjunctive surgical ablation directly (ie, most commonly pulmonary vein isolation or biatrial Cox-Maze IV depending on the preference of the center; Figure 5). [69][70][71][72]98 Although Cox-Maze IV requires multiple incisions within the atria, it does not increase operative risk, albeit sometimes associated with high-degree atrioventricular block requiring a permanent pacemaker.…”

Section: Antiarrhythmic Drugsmentioning

confidence: 99%

“…70 Although the surgical ablation data appear superior to catheter ablation in HCM, a direct comparison between these procedures is difficult considering that concomitant myectomy normalizes LA and LV systolic pressures, which itself is seen as also decreasing the likelihood of AF recurrences. 3,21,97 In patients with HCM undergoing surgical AF ablation at the time of myectomy, either LA appendage excision or clip is typically performed to exclude the LA appendage as a potential source of thrombus formation. 72,99 However, there have been no clinical trials directly comparing LA appendage excision or clip in HCM, nor data related to long-term embolic stroke risk after these procedures.…”

Section: Antiarrhythmic Drugsmentioning

confidence: 99%

See 1 more Smart Citation

Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Rowin,

Link,

Maron

et al. 2023

Circulation

Self Cite

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with clinical and subclinical episodes occurring in nearly one-half of patients. AF in HCM historically has been characterized as a decisive disease complication associated with substantial risk for thromboembolic stroke and increased morbidity and mortality. However, there have been many advances in treatment strategy resulting in improved outcomes for this patient group. For example, stroke risk in HCM has been greatly reduced by using systemic oral anticoagulation initiated after the first clinical (symptomatic) AF episode, usually with preference given to direct anticoagulants over warfarin. In contrast, stroke risk scoring systems (such as CHA 2 DS 2 -VASc score) are not informative in HCM given the substantial potential for stroke events in patients with low scores, and therefore should not be used for anticoagulation decisions in this disease. A novel risk score specifically designed for HCM (HCM-AF score) can reliably identify most patients with HCM at risk for future AF. Although a strategy focused on controlling ventricular rate is effective in asymptomatic (or minimally symptomatic) patients with AF, restoring and maintaining sinus rhythm is required for most patients with marked AF symptom burden and impaired quality of life. Several antiarrhythmic drugs such as sotalol, disopyramide, and amiodarone, can be effective in suppressing AF episodes; albeit safe, long-term efficacy is supported by only limited data. Catheter AF ablation has emerged as an important treatment option for some patients, although freedom from AF after a single ablation is relatively low (35% at 3 years), multiple ablations and the concomitant use of antiarrhythmic drugs can control AF with more than two-thirds of patients maintaining sinus rhythm at 5 years. Surgical AF ablation with biatrial Cox-Maze IV performed as an adjunctive procedure during myectomy can reduce symptomatic AF episodes (70% of patients free from AF at 5 years). For the vast majority of patients who have HCM with AF, the implementation of contemporary therapies has allowed for improved quality of life and low HCM-related mortality.

show abstract

Section: Antiarrhythmic Drugsmentioning

confidence: 99%

Section: Antiarrhythmic Drugsmentioning

confidence: 99%

Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Rowin,

Link,

Maron

et al. 2023

Circulation

Self Cite

View full text Add to dashboard Cite

show abstract

“…The decision to proceed with adjuvant mitral valve modification during surgery is guided by the adequate identification of abnormal submitral apparatus, identified by multimodality imaging and confirmed by direct visualization during the procedure [19,34,43]. The presence of a posterior mitral regurgitation jet, in the absence of obvious other mitral valve disease, is deemed typical of SAM-mediated mitral regurgitation.…”

Section: Surgical Myectomymentioning

confidence: 99%

The mitral valve in hypertrophic cardiomyopathy

Malcolmson

Shipolini

Mohiddin

et al. 2023

Current Opinion in Cardiology

View full text Add to dashboard Cite

Purpose of review Whilst abnormally increased left ventricular wall thickness is the hallmark feature of hypertrophic cardiomyopathy (HCM), anomalies of the mitral valve and supporting apparatus are well documented. This review addresses the clinical importance of mitral valve abnormalities in HCM, their mechanistic associations with symptoms, and therapeutic strategies targeting mitral valve and apparatus abnormalities. Recent findings The normal mitral valve possesses anatomical features facilitating unrestricted blood flow during LV filling, preventing regurgitation during LV systole, and avoiding obstruction of LV ejection. In HCM, a variety of structural and functional abnormalities can conspire to cause deranged mitral valve function, with implications for management strategy. Identification and characterization of these abnormalities is facilitated by multimodality imaging. Alcohol septal ablation (ASA) cannot address primary mitral valve abnormalities, and so is not preferred to surgical intervention if mitral valve abnormalities are present and are judged to make dominant contributions to LV outflow tract obstruction (LVOTO). Two broadly opposing surgical intervention strategies exist, one advocating isolated septal myectomy and the other including adjuvant mitral apparatus modification. Newer, less invasive surgical and transcatheter techniques will expand interventional options. Summary Mitral valve abnormalities are a central pathological feature of HCM. Multimodality imaging is crucial for their identification and characterization prior to therapeutic intervention.

show abstract

“…Although both septal myectomy and alcohol septal ablation can achieve a mortality rate of <1%, clinical results depend on the expertise offered by high-volume centers. 4,5 What has been lacking is novel therapies that might reduce or even eliminate the need for invasive SRT procedures. The development of mavacamten, a small-molecule allosteric modulator of cardiac myosin and a strong negative inotropic agent, was welcomed as an important new therapeutic option.…”

mentioning

confidence: 99%

Can Novel Myosin Inhibitors Defer Septal Reduction Therapy in HCM? At What Risk and at What Cost?

Rakowski

Bataiosu

2023

Circulation

Self Cite

View full text Add to dashboard Cite

Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel

Cited by 34 publications

References 149 publications

Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

The mitral valve in hypertrophic cardiomyopathy

Can Novel Myosin Inhibitors Defer Septal Reduction Therapy in HCM? At What Risk and at What Cost?

Contact Info

Product

Resources

About