Surgical Treatment Of Hypertrophic Cardiomyopathy Research Articles

Comparing long-term outcomes of septal myectomy and mitral valve replacement in hypertrophic cardiomyopathy patients: A retrospective cohort study in Iran.

Hypertrophic cardiomyopathy (HCM) affects millions of individuals worldwide. In severe cases, it can cause life-threatening conditions such as left ventricular outflow tract (LVOT) obstruction, mitral regurgitation (MR), and sudden cardiac death, making surgical treatment necessary. This study aimed to report the long-term outcomes of HCM patients undergoing septal myectomy or mitral valve replacement (MVR) and compare the results between different types of surgeries. This was a retrospective cohort study on HCM patients who underwent surgical treatment in an Iranian referral center between 2005 and 2021. Patients were divided into three groups according to the type of surgery received: septal myectomy, MVR, or a combination of both surgeries. Patient characteristics, surgical and echocardiographic features, and in-hospital and long-term outcomes were reported and compared between the three groups. A total of 102 patients with an average age of 53.3 ± 16.9 were included. Twenty-six patients had septal myectomy, 23 had MVR, and 53 had combined septal myectomy and MVR surgery. All surgeries were associated with a significant reduction in interventricular septum thickness and LVOT gradients. After a median of 6.8-year follow-up time, patients with an isolated septal myectomy had significantly lower mortality and major adverse cardiac and cerebrovascular events rates than the other groups. Isolated septal myectomy showed better long-term survival rates and can correct HCM-related MR, while MVR should be preserved only for intrinsic valve defects. More extensive studies are needed to confirm these findings and achieve a comprehensive guideline on surgical treatment of HCM.

Historical and modern aspects of surgical treatment of hypertrophic cardiomyopathy in children (literature review)

Hypertrophic cardiomyopathy (HCM) is a common, genetically determined myocardial pathology that can manifest itself at any age. The manifestation of this pathology in childhood always means a high risk of sudden cardiac death and the rapid progression of symptoms. The annual mortality in asymptomatic patients over 1 year is 1%. There are many recommendations for the management of patients with obstructive cardiomyopathy, but they are all written for the adult population. Drug treatment of symptomatic patients with this pathology is effective only in 70% of patients. The remaining 30% should be given preference to surgical treatment. It is important for a cardiac surgeon to know the main methods of HCM correction, their advantages and disadvantages. The literature review shows the evolution of methods of surgical correction of obstructive HCM from the middle of the 20th century until now. The main surgical methods for treating left ventricular outflow tract obstruction, correcting SAM-syndrome (systolic anterior motion syndrome) and mitral insufficiency, which have had a great influence on the development of HCM surgery, are presented. A clinical experience of treating left ventricular outflow tract obstruction in children is presented. The most promising method today is “transaortic extended septal myectomy”. Thus, there is a need to evaluate and modify existing methods for correcting obstructive HCM and their complications. Works aimed at their improvement and elimination of shortcomings are promising.

Sudden cardiac risk assessment in hypertrophic cardiomyopathy: role of the imaging

The current knowledge about imaging in the sudden cardiac death (SCD) risk assessment in hypertrophic cardiomyopathy (HCMP) is discussed. The overall risk of SCD in patients with HCMP is not high, but it remain the main cause of death in young patients. Implantation of cardioverter-defibrillator, surgical treatment of HCMP allow to prevent SCD and other negative cardiovascular events (heart failure and stroke) in patients with HCMP. Thus identification of predictors of negative cardiovascular events is essential in HCMP. Imaging methods (echocardiography and magnetic resonance imaging) enable to assess risk factors: left ventricular hypertrophy, left ventricular outflow tract obstruction, left atrial dimension, apical aneurysm, midventricular obstruction and extent of the late gadolinium enhancement. Role of the risk factors in SCD risk assessment in HCMP is discussed in the article.

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

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

Outcomes following transaortic septal myectomy in hypertrophic cardiomyopathy

Background: The objective of the study was to evaluate effect of myectomy and its impact on survival for a period of one year and to identify the co-morbid conditions that would increase the risk of surgery.Methods: The study was conducted on the patients admitted in a single unit of department of cardiothoracic surgery, NIMS, Hyderabad during the period of 2014 to 2018. The study was a retrospective observational study. 21 patients were enrolled in the study after approval from institute ethics committee. All the patients between 7 to 70 years who underwent septal myectomy were included in the study.Results: Out of the 21 patients underwent modified Morrows myectomy 16 (76.2%) were male and 5 (23.8%) were female. The most common presenting symptom was dyspnea (81%), followed chest pain (76%), palpitations (62%) and syncope (38%). 5 (24%) patients had a family history of sudden cardiac death. Preoperative beta blockers were used by 15 (72%) patients. 11 patients had severe mitral regurgitation, out of which 8 patients underwent valve replacement and 3 underwent mitral valve repair. The mean preoperative left ventricular outflow tract obstruction gradient was 86.86 and the mean postoperative gradient was 23.47. 3 patients had implantable cardioverter defibrillator insertions. All patients had symptom relief.Conclusions: Surgical treatment of hypertrophic cardiomyopathy through transaortic septal myectomy is safe and effective method to relieve left ventricular outflow tract obstruction. Mitral valve replacement can be done for cases with structural defect of mitral valve. Early detection and intervention in patients with family history of sudden cardiac death would reduce the risk of death and ensure long term survival.

Hypertrophic cardiomyopathy: current state of the problem

The main aspects of epidemiology, pathophysiology, medication and surgical treatment of hypertrophic cardiomyopathy (HCM) are reviewed in the article. The authors emphasize that surgical treatment is still the method of choice for HCM and can guarantee excellent immediate and long-term results with minimal risk.

Surgical treatment of hypertrophic cardiomyopathy: what’s new?

The aim — to investigate the effectiveness of surgical septal myectomy in patients with obstructive form of hypertrophic cardiomyopathy (HCM) and to determine its effect on survival and quality of life.Materials and methods. The research included 118 consequential symptomatic patients with obstructive form of HCM who underwent surgical extensive myectomy with secondary chordae resection and mobilization of the anterior and posterior groups of papillary muscles (PM). An evaluation of the following parameters in group of patients before and after surgical intervention was performed: systolic pressure gradient (SPG) on the left ventricle outflow tract (LVOT), mitral regurgitation (MR) degree, NYHA functional class, survival rate and main post­operative complications.Results and discussion. According to the obtained data, SPG decreased from 93.6 ± 23.2 mmHg prior the surgery to 19.7 ± 11.4 mmHg after the treatment (p < 0.001). 21 (17.8 %) patients had moderate degree of MR after the surgery, while before the intervention the number of patients who had moderate or severe MR degree made up 101 (85.5 %) out of 118 (p < 0.001). Out of 118 patients, 36 (30.5 %) of whom had III — IV NYHA functional class of heart failure before the procedure, 115 (97.4 %) switched to functional class I — II in the latest follow­up (p < 0.001). The mortality accounted for 1.7 %. Out of 118 patients under study, one (0.8 %) underwent cardioverter­defibrillator implantation in the post­operative period for the prophilaxis of sudden death, and 5 (4.2 %) patients underwent pacemaker implantation due to complete post­operative AV­block.Conclusions. Surgical septal myectomy by professor P. Ferrazzi procedure is a gold standard of treatment of patients with obstructive form of HCM. Successful correction of HCM can be conducted only by a high­qualified surgeon with experience of reconstruction of valvular pathologies and in an expert center, where it is possible to perform routine pre­operative MRI or CT‑planning and mandatory intraoperative echocardiographic control.

Transmitral Septal Myectomy for Hypertrophic Obstructive Cardiomyopathy

Intrinsic abnormalities of the mitral valve are common in patients with hypertrophic cardiomyopathy and may need to be addressed at operation. Consecutive patients undergoing transmitral septal myectomy were retrospectively reviewed. The ventricular septum was exposed through a left atriotomy, and the anterior leaflet of the mitral valve was detached from its annulus. An extended myectomy was performed to the base of the papillary muscles. After myectomy, the anterior leaflet was reattached and concomitant mitral valve repair or replacement was performed. In some cases, we performed a modified anterolateral commissural closure suture, which served to reposition the lateral aspect of the anterior leaflet out of the left ventricular outflow tract ("curtain stitch"). Twenty patients who underwent this procedure were identified (70% women; mean age 63 years). Mitral regurgitation was moderate in 55% and severe in 40%. Preoperative peak left ventricular outflow tract gradient was 92 ± 43 mm Hg. Mitral valve repair (n= 11) or replacement (n= 9) was performed. Predischarge transthoracic echocardiography demonstrated a left ventricular outflow tract gradient of 10 ± 5 mm Hg. There was no operative mortality. Follow-up was 100% complete and averaged 22 ± 25 months. No patient required reoperation, and there was no recurrence of left ventricular outflow tract obstruction or mitral regurgitation greater than mild. Potential advantages of transmitral myectomy include a panoramic view of the septum and mitral subvalvular apparatus and the ability to simultaneously address mitral valve pathology. Consideration should be given to using the transmitral approach to septal myectomy as the preferred approach for the surgical treatment of hypertrophic cardiomyopathy.

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective

Surgical treatment for hypertrophic cardiomyopathy: a historical perspective.

Our understanding of hypertrophic cardiomyopathy (HCM) as a disease entity has increased dramatically over the last half century. There has been a concerted effort by several surgical groups to develop operative techniques to relieve left ventricular outflow tract (LVOT) obstruction and alleviate symptoms. This paper traces the development of transaortic septal myectomy, the current gold standard therapy for relief of LVOT obstruction, in symptomatic patients refractory to medical treatment. In addition, we introduce newer methods for myectomy that have expanded the role of surgery in patients with various forms of HCM.

Surgery for hypertrophic cardiomyopathy.

Hypertrophic cardiomyopathy (HCM) is a genetically determined cardiac disease characterised by otherwise unexplained myocardial hypertrophy of the left ventricle, and may result in left ventricular outflow tract obstruction. It is the most common cause of sudden cardiac death in young adults due to arrhythmias. Septal myectomy is a surgical treatment for HCM with moderate to severe outflow tract obstruction, and is indicated for patients with severe symptoms refractory to medical therapy. The surgical approach involves obtaining access to the interventricular septum via transaortic, transapical or transmitral approaches, and excising a portion of the hypertrophied myocardium to relieve the outflow tract obstruction. Large, contemporary series from centres experienced in septal myectomy patients have demonstrated a low early mortality of <2%, excellent long-term survival that matches the general population, and durable relief of symptoms.

Surgical treatment of hypertrophic cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a clinical entity in which there is unexplained hypertrophy of the left ventricle in the absence of another cardiac or systemic etiology. Variants of HCM may include basal, midventricular, apical or diffuse types. In this review, the authors summarize the current surgical treatment and outcomes of septal myectomy in HCM. HCM is a unique primary myocardial disease characterized by hypertrophy of the myocardium. It is associated with a variety of presentations that range from asymptomatic to sudden cardiac death. Previously known as idiopathic hypertrophic subaortic stenosis, HCM is recognized as a genetic predisposition to myocardial hypertrophy. Medical treatment is the first-line therapy for patients with symptoms due to left ventricular outflow tract obstruction. However, septal myectomy continues to be an excellent treatment option for those intolerant of or unresponsive to medical therapy. In this paper, the authors review the role of surgery in HCM and the different variants of this unique disease.

Surgical Treatment of Hypertrophic Cardiomyopathy

Hypertrophic cardiomyopathy (HCM) is a unique primary myocardial disease characterized by unexplained left ventricular hypertrophy in absence of another etiology. One of the key features is the presence of systolic anterior motion of the anterior leaflet of the mitral valve which causes left ventricular outflow tract obstruction with various degrees of mitral valve regurgitation. Surgical septal myectomy is the preferred treatment of choice if medical treatment is unsuccessful or intolerable. We summarize in this review the available treatment options for HCM.

The Actis-Gouge: a Simple Cutting Tool for Proper Muscular Resection in Hypertrophic Cardiomyopathy

Background : Surgical treatment of hypertrophic cardiomyopathy (HC) may be challenging for the risk of surgical complications or insufficient resection. We present our cutting tool to perform proper muscular resection in HC. Material and methods : Ten patients (5 males, mean age 43,1 ± 19,6 years, range 9–70 years) were operated on for HC using this semicircular cutting device. Combined procedures were: mitral valve repair (n = 1), mitral valve replacement (n = 2), right ventricular myectomy (n = 1), aortic valve replacement (n = 1), mitral and aortic replacement (n = 1). Results : There was one early death. All the surviving patients are alive over a variable follow up from 2 to 8 years, with consistent reduction of symptoms: in fact, no patient had residual angina with significant reduction of the NYHA class from 3,2 ± 0,6 to 1,3 ± 0,5 postoperatively (p < 0,05). Muscular resection was effective with significant reduction of sub-valvular gradient from 84.5 + 33,4 mmHg to 14,1 ± 17,6 mmHg (p < 0,05) without complications such as complete atrio-ventricular block or ventricular septal defects.Conclusion : Our semicircular myotome is an effective tool to perform a safe myectomy and it avoids surgical complications such as atrio-ventricular blocks or sub-valvular injuries. Our experience suggests that this cutting tool offers a reproducible method for muscular resection and it shows appreciable effects in the reduction of sub-valvular gradient with promising results in terms of morbidity and mortality.

Percutaneous closure of a ventricular septal defect after surgical treatment of hypertrophic cardiomyopathy

DOI:€10.1016/j.jtcvs.2006.01.051 J Thorac Cardiovasc Surg 2006;132:173-174 D. De Wolf, Y. Taeymans, B. Suys, D. Matthys and G. Van Nooten hypertrophic cardiomyopathy Percutaneous closure of a ventricular septal defect after surgical treatment ofhttp://jtcs.ctsnetjournals.org/cgi/content/full/132/1/173 located on the World Wide Web at: The online version of this article, along with updated information and services, is

Mitral valve–sparing operation in subaortic stenosis caused by anomalous papillary muscle and discrete subaortic stenosis

1. Borst HG, Walterbusch G, Schaps D. Extensive aortic replacement using the “elephant trunk” prosthesis. Thorac Cardiovasc Surg. 1983; 31:37-40. 2. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991; 5:491-9. 3. Coselli JS, Oberwalder P. Successful repair of mega aorta using reversed elephant trunk procedure. J Vasc Surg. 1998;27:183-8. 4. Westaby S, Katsumata T. Proximal aortic perfusion for complex arch and descending aortic disease. J Thorac Cardiovasc Surg. 1998;115:162-7. 5. Minale C, Splittberger F, Wendt G, Messmer BJ. One-stage intrathoracic repair of extended aortic aneurysms. J Card Surg. 1994;9:604-13. 6. Dake MD, Miller DC, Semba CP, Mitchell RS, Walker PJ, Lindell HP. Transluminal placement of endovascular stent-grafts for the treatment of descending thoracic aortic aneurysms. N Engl J Med. 1994;331: 1729-34. 7. Palma JH, Almeida DR, Carvalho AC, Andrade JC, Buffolo E. Surgical treatment of acute type B aortic dissection using an endoprosthesis (elephant trunk). Ann Thorac Surg. 1997;63:1081-4. 8. Orihashi K, Sueda T, Watari M, Okada K, Ishii O, Matsuura Y. Endovascular stent-grafting via the aortic arch for distal aortic arch aneurysm: an alternative to endovascular stent-grafting. Eur J Cardiothorac Surg. 2001;20:973-8. 9. Griepp RB. Cerebral protection during aortic arch surgery. J Thorac Cardiovasc Surg. 2001;121:425-7. 10. Bachet J, Guilmet D, Goudot B, Dreyfus GD, Delentdecker P, Brodaty D, et al. Antegrade cerebral perfusion with cold blood: a 13-year experience. Ann Thorac Surg. 1999;67:1874-8. 11. Hagl C, Ergin MA, Galla JD, Lansman SL, McCullough JN, Spielvogel D, et al. Neurologic outcome after ascending aorta-aortic arch operations: effect of brain protection technique in high-risk patients. J Thorac Cardiovasc Surg. 2001;121:1107-21.

763-6 Septal Myectomy for Hypertrophic Cardiomyopathy: Echocardiographic Predictors of Postoperative Outcome

Although septal myectomy (SM) reduces the left ventricular outflow tract (LVOT) pressure gradient and relieves symptoms in the majority of patients with severe hypertrophic cardiomyopathy (HCM). there remains a subset of patients who will continue to have residual limiting symptoms. In order to determine whether echo/Doppler (ECHO) can predict outcome after surgical treatment of HCM, we analyzed the clinical and ECHO characteristics of 47 consecutive HCM patients aged 20 to 70 years (mean 47 ± 15 years, M:F = 1:1) undergoing isolated SM from 1986 to 1992 for NYHA class 3 or 4 symptoms. Preoperative symptoms included dyspnea (100%), angina (64%), near syncope (62%), and syncope (23%). At postoperative follow-up (12 ± 4 months). there was marked overall improvement; 94% were NYHA class 1 or 2. Persistent symptoms were dyspnea (55%), angina (15%), and near syncope (15%). By multivariate analysis of all clinical and ECHO parameters, only the preoperative ECHO variable of hypertrophy pattern (diffuse hypertrophy≥ 15 mm versus septal localization ± anterolateral extension) emerged as an independent predictor of residual dyspnea postoperatively (p = 0.05). Variables not predictive included peak rest and provoked LVOT gradient, ejection time, mitral regurgitation severity, mitral flow velocity curves, left atrial volume, and left ventricular mass index. With the successful relief of LVOT obstruction by SM, most HCM patients experience significant improvement in symptoms of angina. near syncope, and syncope. The morphological characteristic of diffuse (concentric) left ventricular hypertrophy is a superior predictor of residual postoperative dyspnea as compared to Doppler parameters. This diffuse hypertrophy may be indicative of severe diastolic filling abnormalities which are unchanged by SM.

Intermediate and late follow-up of the use of apico-aortic conduits in the surgical treatment of hypertrophic cardiomyopathy

Between December 1977 and July 1983, four apico-aortic prosthetic valved conduits were implanted in four patients affected by severe hypertrophic cardiomyopathy. The disease was isolated in two cases, associated with critical stenosis of the right coronary artery in one case and with a subaortic tunnel plus aortic valve regurgitation in the final case. Three patients were male and one female; the ages ranged from 6 to 49 years. All patients survived surgery and were followed-up. At present, all are living and have no postoperative symptoms. The left ventricular-aortic gradient was relieved in all cases. Echocardiographic studies during the follow-up showed an enlargement of the left ventricular cavity with a satisfactory cardiac contraction. Three years following surgery the female patient gave birth to a normal male baby. Her pregnancy was normal and without complications. Seven years after surgery the first patient was successfully reoperated because of conduit thrombosis caused by degeneration of the biological porcine valve. In the follow-up, which ranges from 18 months to 7 years (mean 4.5 years) all patients are in Functional Class I. All preoperative symptoms have been relieved for all patients and there has been no incidence of late or sudden death.

Surgical treatment of hypertrophic cardiomyopathy (Düsseldorf experience)

Surgical treatment appears to be the therapy of choice in hypertrophic, obstructive cardiomyopathy, at least in patients who are in the advanced stage of the disease and refractory to medical treatment. In addition, strong evidence has been obtained that surgical treatment improved the prognosis at least in patients who required only a myectomy via a transaortic approach.

Medical and surgical treatment of hypertrophic cardiomyopathy.

Medical and surgical treatment of hypertrophic cardiomyopathy.