Edge-to-edge mitral valve repair in the surgical treatment of hypertrophic cardiomyopathy

Abstract

Septal myectomy is the method of choice for treating symptomatic left ventricular outlet obstruction in patients with hypertrophic cardiomyopathy who are resistant to drug therapy. An important role in persistence, residual obstruction, mitral valve abnormalities and anterior systolic mitral valve movement is systolic anterior motion. Several authors have reported the use of edge-to-edge mitral valve repair in addition to septal myectomy in patients with mild septal hypertrophy. We performed a literature review on the surgical treatment of obstructive hypertrophic cardiomyopathy—mitral valve repair using the edge-to-edge technique with septal myectomy. Four retrospective studies and three clinical cases were analysed. The data of patients who underwent mitral valve repair surgery using the edge-to-edge technique with septal myectomy and had satisfactory long-term clinical and hemodynamic results were studied. This treatment technique should be considered in cases of unexpressed hypertrophy when isolated limited myectomy is insufficient to eliminate the left ventricular outlet or when there is a hemodynamically significant mitral insufficiency caused by anterior systolic movement of the mitral valve that increases the need for intervention on interventricular hypertrophy of the associated disease. Septal defect, plastic mitral valve, surgically significant residual mitral regurgitation and high residual left ventricular outflow gradients in long-term follow-up are feasible, safe and effective for anterior systolic mitral valve movement. Received 28 September 2020. Revised 23 March 2021. Accepted 25 March 2021. Funding: The study did not have sponsorship. Conflict of interest: Authors declare no conflict of interest. Author contributionsConception and study design: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-ProkophievData collection and analysis: S.A. Budagaev, M.A. Ovchinnikova, A.N. Pivkin, I.I. DeminDrafting the article: S.A. Budagaev, A.V. AfanasyevCritical revision of the article: A.V. Bogachev-Prokophiev, D.A. AstapovFinal approval of the version to be published: S.A. Budagaev, A.V. Afanasyev, A.V. Bogachev-Prokophiev, M.A. Ovchinnikova, A.N. Pivkin, D.A. Astapov, I.I. Demin