Abstract

Background Mitral subvalvular procedures have acquired a major role during hypertrophic obstructive cardiomyopathy (HOCM) surgery. However, few studies have focused on characterizing the clinical feature of HOCM patients without intrinsic mitral valve (MV) diseases undergoing mitral subvalvular procedures in addition to myectomy. Additionally, scant data about the results of mitral subvalvular procedures during HOCM surgery are available. This single-center study aims to characterize the clinical feature and surgical results of HOCM patients without intrinsic MV diseases undergoing mitral subvalvular procedures in addition to myectomy in comparison with those receiving myectomy alone. Methods Among 181 eligible patients, 50 (27.6%) patients undergoing myectomy plus mitral subvalvular procedures were entered into the combined group, and the remaining 131 patients receiving myectomy alone were included in the alone group. Baseline and surgical characteristics were investigated, and surgical results were compared. Results Comparatively, the combined group was younger (52.9 ± 11.2 years vs. 56.8 ± 11.8 years, p=0.045) and had a better New York Heart Association (NYHA) class (p=0.034) and less septal hypertrophy (16.4 ± 2.3 mm vs. 18.5 ± 3.2 mm, p < 0.001). Septal thickness was independently associated with combined procedures in multivariable logistic regression analysis (OR = 0.887, 95% CI 0.612–0.917). No surgical death or iatrogenic septal perforation occurred in the combined group. Two (6.5%) patients in the combined group developed complete atrioventricular block and required permanent pacemaker implantation. During a median follow-up of 10 months, no deaths or reoperations were observed with the symptom of relief and NYHA class I or II in either group. Patients in the combined group as compared to the alone group had lower outflow tract gradients and a lower incidence of residual systolic anterior motion (SAM) syndrome. Conclusions For HOCM patients without intrinsic MV diseases who are scheduled for surgery, a less pronounced septal hypertrophy may be closely associated with myectomy with concomitant mitral subvalvular procedures instead of myectomy alone. Mitral subvalvular procedures during myectomy are safe and allow the reduction of outflow tract gradients and freedom from SAM more effectively in comparison with myectomy alone.

Highlights

  • Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease with the characterization of asymmetrical left ventricular hypertrophy [1]

  • According to Mayo’s experience [8], myectomy alone may be sufficient in the relief of LVOTobstruction and in the elimination of mitral regurgitation (MR) in the overwhelming majority of hypertrophic obstructive cardiomyopathy (HOCM) patients, and concomitant mitral valve (MV) surgery has been required only in 2.1% of HOCM patients without intrinsic MV diseases

  • Increasing studies [9, 10] have reported that mitral subvalvular anomalies, including fibrotic anterior leaflet attachment and abnormalities of the papillary muscles (PMs) and secondary chordae [11], may play an important role in the etiology of HOCM, and myectomy alone may receive incomplete or only temporary relief of left ventricular outflow tract (LVOT) obstruction in a subgroup of HCM patients without intrinsic MV diseases

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Summary

Introduction

Hypertrophic cardiomyopathy (HCM) is a genetic myocardial disease with the characterization of asymmetrical left ventricular hypertrophy [1]. Increasing studies [9, 10] have reported that mitral subvalvular anomalies, including fibrotic anterior leaflet attachment and abnormalities of the papillary muscles (PMs) and secondary chordae [11], may play an important role in the etiology of HOCM, and myectomy alone may receive incomplete or only temporary relief of LVOT obstruction in a subgroup of HCM patients without intrinsic MV diseases. Few studies have focused on characterizing the clinical feature of HOCM patients without intrinsic mitral valve (MV) diseases undergoing mitral subvalvular procedures in addition to myectomy. Is single-center study aims to characterize the clinical feature and surgical results of HOCM patients without intrinsic MV diseases undergoing mitral subvalvular procedures in addition to myectomy in comparison with those receiving myectomy alone. For HOCM patients without intrinsic MV diseases who are scheduled for surgery, a less pronounced septal hypertrophy may be closely associated with myectomy with concomitant mitral subvalvular procedures instead of myectomy alone. Mitral subvalvular procedures during myectomy are safe and allow the reduction of outflow tract gradients and freedom from SAM more effectively in comparison with myectomy alone

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