Extended septal myectomy for obstructive hypertrophic cardiomyopathy and its impact on mitral valve function.
Journal
Journal of cardiovascular medicine (Hagerstown, Md.)
ISSN: 1558-2035
Titre abrégé: J Cardiovasc Med (Hagerstown)
Pays: United States
ID NLM: 101259752
Informations de publication
Date de publication:
16 Jan 2024
16 Jan 2024
Historique:
medline:
22
1
2024
pubmed:
22
1
2024
entrez:
22
1
2024
Statut:
aheadofprint
Résumé
Septal myectomy is the treatment of choice for hypertrophic obstructive cardiomyopathy (HOCM). Around 30-60% of patients with HOCM have a secondary mitral valve regurgitation due to systolic anterior motion (SAM). We report our experience with extended septal myectomy and its impact on the incidence of concomitant mitral valve procedures. This is a retrospective study on 84 patients who underwent SM from January 2008 to February 2022. Surgical procedure was performed according to the concept of 'extended myectomy' described by Messmer in 1994. Follow-up outcomes in terms of survival, hospital admissions for heart failure or MV disease, cardiac reoperations, and pacemaker (PMK) implantation were recorded. Mean age was 61 ± 15 years. Mitral valve surgery was performed in seven cases (8%); particularly only one patient without degenerative mitral valve disease underwent mitral valve surgery, with a plicature of the posterior leaflet. In-hospital mortality was 5%. Mitral valve regurgitation greater than mild was present in four patients (5%) at discharge. Twelve-year survival was 78 ± 22%. Cumulative incidence of rehospitalization for heart failure and rehospitalization for mitral valve disease was 10 ± 4 and 2.5 ± 2.5%, respectively. PMK implantation was 5% at discharge, with a cumulative incidence of 15 ± 7%. Freedom from cardiac reoperations was 100%. Septal myectomy for HOCM is associated with good outcomes. Although concomitant surgery on the mitral valve to address SAM and associated regurgitation has been advocated, these procedures were needed in our practice only in patients with intrinsic mitral valve disease. Adequate myectomy addresses the underlying pathophysiology in most patients.
Identifiants
pubmed: 38251434
doi: 10.2459/JCM.0000000000001588
pii: 01244665-990000000-00179
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 Italian Federation of Cardiology - I.F.C. All rights reserved.
Références
Elliott PM, Anastasakis A, et al. Authors/Task Force Members 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and management of hypertrophic cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35:2733–2779.
Semsarian C, Ingles J, Maron MS, Maron BJ. New perspectives on the prevalence of hypertrophic cardiomyopathy. J Am Coll Cardiol 2015; 65:1249–1254.
Maron BJ, Maron MS. Hypertrophic cardiomyopathy. Lancet 2013; 381:242–255.
Autore C, Bariani R, Bauce B, et al. From the phenotype to precision medicine: an update on the cardiomyopathies diagnostic workflow. J Cardiovasc Med (Hagerstown) 2023; 24: (Suppl 2): e178–e186.
Prinz C, Farr M, Hering D, Horstkotte D, Faber L. The diagnosis and treatment of hypertrophic cardiomyopathy. Deutsch Ärztebl Int 2011; 108:209–215.
Maron MS, Olivotto I, Betocchi S, et al. Effect of left ventricular outflow tract obstruction on clinical outcome in hypertrophic cardiomyopathy. N Engl J Med 2003; 348:295–303.
Ommen SR, Mital S, Burke MA, et al. 2020 AHA/ACC Guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation 2020; 142:e558–e631.
Morrow AG, Reitz BA, Epstein SE, et al. Operative treatment in hypertrophic subaortic stenosis: techniques and the results of pre and postoperative assessments in 83 patients. Circulation 1975; 52:88–102.
Messmer BJ. Extended myectomy for hypertrophic obstructive cardiomyopathy. Ann Thorac Surg 1994; 58:575–577.
Schoendube FA, Klues HG, Reith S, Flachskampf FA, Hanrath P, Messmer BJ. Long-term clinical and echocardiographic follow-up after surgical correction of hypertrophic obstructive cardiomyopathy with extended myectomy and reconstruction of the subvalvular mitral apparatus. Circulation 1995; 92:122–127.
Wei LM, Thibault DP, Rankin JS, et al. Contemporary surgical management of hypertrophic cardiomyopathy in the United States. Ann Thorac Surg 2019; 107:460–466.
Jiang L, Levine RA, King ME, Weyman AE. An integrated mechanism for systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy based on echocardiographic observations. Am Heart J 1987; 113:633–644.
Sherrid MV, Chu CK, Delia E, Mogtader A, Dwyer EM Jr. An echocardiographic study of the fluid mechanics of obstruction in hypertrophic cardiomyopathy. J Am Coll Cardiol 1993; 22:816–825.
Guigui SA, Torres C, Escolar E, Mihos CG. Systolic anterior motion of the mitral valve in hypertrophic cardiomyopathy: a narrative review. J Thorac Dis 2022; 14:2309–2325.
Ro R, Halpern D, Sahn DJ, et al. Vector flow mapping in obstructive hypertrophic cardiomyopathy to assess the relationship of early systolic left ventricular flow and the mitral valve. J Am Coll Cardiol 2014; 64:1984–1995.
Schaff HV, Said SM. Transaortic extended septal myectomy for hypertrophic cardiomyopathy. Oper Tech Thorac Cardiovasc Surg 2012; 17:238–250.
Morrow AG, Fogarty TJ, Hannah H 3rd, Braunwald E. Operative treatment in idiopathic hypertrophic subaortic stenosis: techniques, and the results of preoperative and postoperative clinical and hemodynamic assessments. Circulation 1968; 37:589–596.
McCully RB, Nishimura RA, Tajik AJ, Schaff HV, Danielson GK. Extent of clinical improvement after surgical treatment of hypertrophic obstructive cardiomyopathy. Circulation 1996; 94:467–471.
Kotkar KD, Said SM, Dearani JA, Schaff HV. Hypertrophic obstructive cardiomyopathy: the Mayo Clinic experience. Ann Cardiothorac Surg 2017; 6:329–336.
Heric B, Lytle BW, Miller DP, Rosenkranz ER, Lever HM, Cosgrove DM. Surgical management of hypertrophic obstructive cardiomyopathy: early and late results. J Thorac Cardiovasc Surg 1995; 110:195–206.
Maron BJ, Dearani JA, Ommen SR, et al. The case for surgery in obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2004; 44:2044–2053.
Woo A, Williams WG, Choi R, et al. Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. Circulation 2005; 111:2033–2041.
Maron BJ, McKenna WJ, Danielson GK, et al. American College of Cardiology/European Society of Cardiology clinical expert consensus document on hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation Task Force on Clinical Expert Consensus Documents and the European Society of Cardiology Committee for Practice Guidelines. J Am Coll Cardiol 2003; 42:1687–1713.
Ommen SR, Maron BJ, Olivotto I, et al. Long-term effects of surgical septal myectomy on survival in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 2005; 46:470–476.
Cho YH, Quintana E, Schaff HV, et al. Residual and recurrent gradients after septal myectomy for hypertrophic cardiomyopathy: mechanisms of obstruction and outcomes of reoperation. J Thorac Cardiovasc Surg 2014; 148:909–915.
Sherrid MV, Balaram S, Kim B, Axel L, Swistel DG. The mitral valve in obstructive hypertrophic cardiomyopathy: a test in context. J Am Coll Cardiol 2016; 67:1846–1858.
Kadkhodayan A, Schaff HV, Eleid MF. Anomalous papillary muscle insertion in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 2016; 17:588.
Song HK, Turner J, Macfie R, et al. Routine papillary muscle realignment and septal myectomy for obstructive hypertrophic cardiomyopathy. Ann Thorac Surg 2018; 106:670–675.
Levine RA, Schwammenthal E, Song JK. Diastolic leading to systolic anterior motion: new technology reveals physiology. J Am Coll Cardiol 2014; 64:1996–1999.
Kaple RK, Murphy RT, DiPaola LM, et al. Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes. Ann Thorac Surg 2008; 85:1527–1535. 1535.e1-2.
Massera D, Xia Y, Li B, Riedy K, Swistel DG, Sherrid MV. Mitral annular calcification in hypertrophic cardiomyopathy. Int J Cardiol 2022; 349:83–89.
Wan CK, Dearani JA, Sundt TM 3rd, Ommen SR, Schaff HV. What is the best surgical treatment for obstructive hypertrophic cardiomyopathy and degenerative mitral regurgitation? Ann Thorac Surg 2009; 88:727–731.
Hong J, Schaff HV, Ommen SR, Abel MD, Dearani JA, Nishimura RA. Mitral stenosis and hypertrophic obstructive cardiomyopathy: an unusual combination. J Thorac Cardiovasc Surg 2016; 151:1044–1048.
Hong JH, Schaff HV, Nishimura RA, et al. Mitral regurgitation in patients with hypertrophic obstructive cardiomyopathy: implications for concomitant valve procedures. J Am Coll Cardiol 2016; 68:1497–1504.
Yu EH, Omran AS, Wigle ED, Williams WG, Siu SC, Rakowski H. Mitral regurgitation in hypertrophic obstructive cardiomyopathy: relationship to obstruction and relief with myectomy. J Am Coll Cardiol 2000; 36:2219–2225.
Cooley DA. Surgical techniques for hypertrophic left ventricular obstructive myopathy including mitral valve plication. J Card Surg 1991; 6:29–33.
McIntosh CL, Maron BJ, Cannon RO 3rd, Klues HG. Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Circulation 1992; 86:II60–II67.
Kofflard MJ, van Herwerden LA, Waldstein DJ, et al. Initial results of combined anterior mitral leaflet extension and myectomy in patients with obstructive hypertrophic cardiomyopathy. J Am Coll Cardiol 1996; 28:197–202.
Schwammenthal E, Levine RA. Dynamic subaortic obstruction: a disease of the mitral valve suitable for surgical repair? J Am Coll Cardiol 1996; 28:203–206.
Van der Lee C, Kofflard MJ, Van Herwerden LA, Vletter WB, Ten Cate FJ. Sustained improvement after combined anterior mitral leaflet extension and myectomy in hypertrophic obstructive cardiomyopathy. Circulation 2003; 108:2088–2092.
DelmoWalter EM, Siniawski H, Hetzer R. Sustained improvement after combined anterior mitral valve leaflet retention plasty and septal myectomy in preventing systolic anterior motion in hypertrophic obstructive cardiomyopathy in children. Eur J Cardiothorac Surg 2009; 36:546–552.
Nasseri BA, Stamm C, Siniawski H, et al. Combined anterior mitral valve leaflet retention plasty and septal myectomy in patients with hypertrophic obstructive cardiomyopathy. Eur J Cardiothorac Surg 2011; 40:1515–1520.
Nguyen A, Schaff HV, Nishimura RA, et al. Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy? Eur J Cardiothorac Surg 2018; 53:582–589.