Mitral Regurgitation in Patients With Hypertrophic Obstructive Cardiomyopathy: Implications for Concomitant Valve Procedures.

Published on Oct 4, 2016in Journal of the American College of Cardiology24.093
· DOI :10.1016/J.JACC.2016.07.735
Joon Hwa Hong3
Estimated H-index: 3
(Mayo Clinic),
Hartzell V. Schaff132
Estimated H-index: 132
(Mayo Clinic)
+ 4 AuthorsSteve R. Ommen80
Estimated H-index: 80
(Mayo Clinic)
Sources
Abstract
Abstract Background Incidence and outcome of mitral valve (MV) surgery are unknown in patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing extended transaortic septal myectomy. Objectives This study sought to define indications and suitable operative strategy for mitral regurgitation (MR) in patients with HOCM. Methods A total of 2,107 septal myectomy operations performed in adults from January 1993 to May 2014 at Mayo Clinic in Rochester, Minnesota, were retrospectively reviewed. Patients with prior MV operation and apical hypertrophic cardiomyopathy were excluded. Overall, 2,004 operations were performed in 1,993 patients. Results Pre-operative MR was grade ≥3 (of 4) in 1,152 operations (57.5%). Systolic anterior motion of mitral leaflets caused the MR in most patients. However, intrinsic MV disease was identified pre-operatively in 99 patients, all of whom had MV surgery (with septal myectomy). In 1,905 operations, no intrinsic MV disease was identified pre-operatively; in 1,830 (96.1%), septal myectomy was performed without a direct MV procedure. For 75 patients, intrinsic MV disease discovered intraoperatively led to concomitant MV repair (86.7%) or replacement (13.3%). After isolated septal myectomy, the percentage of patients with MR grade ≥3 decreased from 54.3% to 1.7% (p = 0.001) on early post-operative echocardiography. Among 174 patients with concomitant MV surgery, late survival was superior with MV repair (n = 133 [76.4%]) versus replacement (10-year survival: 80.0% vs. 55.2%; p = 0.002). Conclusions In most patients with HOCM, MR related to systolic anterior motion of the MV is relieved through adequate myectomy. Concomitant MV surgery is rarely necessary unless intrinsic MV disease is present. When MV procedures are required, repair is preferred because of improved survival compared with replacement.
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#2Eduard Quintana (University of Barcelona)H-Index: 17
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Objective The aims of the present study were to identify the mechanisms of residual or recurrent left ventricular outflow tract obstruction in patients undergoing repeat septal myectomy for hypertrophic cardiomyopathy and to assess the early and late results of reoperation. Methods From January 1980 to June 2012, we performed 52 repeat myectomies in 51 patients. We reviewed the medical records and preoperative transthoracic echocardiograms to evaluate the adequacy of the previous resection and m...
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A 76-year-old woman with a diagnosis of hypertrophic obstructive cardiomyopathy was referred to our hospital’s surgical department. Her echocardiogram revealed diffuse left ventricular hypertrophy, moderate mitral valve regurgitation with systolic anterior motion of the mitral valve, and left ventricular obstruction with a peak outflow gradient of 108 mm Hg. We performed a transaortic rectangular septal myectomy with an incision at a width, depth, and length of 1 cm, 1 cm, and 3 cm, respectively...
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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...
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#1Qiang Ji (Fudan University)H-Index: 6
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