OC82 TRANSAORTIC MITRAL VALVE REPAIR FOR OBSTRUCTIVE HYPERTROPHIC CARDIOMYOPATHY: THE POLICLINICO DI MONZA EXPERIENCE

Abstract

Background and Aim: Abnormalities of mitral valve (MV) apparatus are known to contribute to left ventricular (LV) outflow obstruction in hypertrophic cardiomyopathy (HCM). Purpose of this study is to report our experience with MV repair in patients with obstructive HCM undergoing surgical septal myectomy. Methods: From July 2013 to March 2018, 316 consecutive patients with obstructive HCM underwent surgical septal myectomy. Of these patients, 298 (94.3%) had associated MV repair and only 18 (5.7%) had MV replacement due to severe leaflets calcification and intrinsic MV disease. Age ranged from 15 to 85 years, mean 54 ± 15. Each patient had an outflow gradient ≥50 mmHg at rest or with physiologic provocation and disabling symptoms unresponsive to medical therapy. Results: Transaortic papillary muscle mobilization and cutting of fibrotic and retracted secondary MV chordae was performed, in association with septal myectomy, in all study patients. Plication of a redundant anterior MV leaflet was performed in 119 (37%) patients, and of the posterior leaflet in 29 (9%). Two patients died during hospitalization (0.6%), 8 patients (2.8%) had a residual postoperative resting gradient ≥30 mmHg, 6 (1.9%) patients had persistent important functional limitation (NYHA III), and 9 (2.8%) residual moderate-to-severe MV regurgitation, at the first postoperative evaluation. Conclusions: In our large HCM study cohort, transaortic extensive and systematic repair of the MV apparatus, combined with septal myectomy, was associated with a particularly low perioperative mortality, and abolition of resting LV outflow obstruction, MV regurgitation and heart failure symptoms in the great majority of patients.