Minimally invasive transmitral septal myectomy for HOCM and intrinsic mitral valve disease significantly reduced resting LVOT gradient from 66 mm Hg to 13 mm Hg at discharge (P=0.025).
Observational (n=19)
Does minimally invasive transmitral septal myectomy combined with mitral valve surgery safely reduce LVOT gradients in patients with HOCM and intrinsic mitral valve disease?
Minimally invasive transmitral septal myectomy combined with mitral valve surgery is feasible, safe, and effectively reduces LVOT gradients in patients with HOCM and degenerative mitral disease without requiring an aortotomy.
Absolute Event Rate: 13% vs 66%
p-value: p=0.025
OBJECTIVE: Transaortic left ventricular septal myectomy described by Morrow is a classical procedure for the treatment of systolic anterior motion of the mitral apparatus associated with hypertrophic obstructive cardiomyopathy (HOCM). We aimed to review our results of transmitral septal myectomy and mitral valve repair/replacement in patients with intrinsic mitral valve disease associated with HOCM, operated on through a minimally invasive approach. METHODS: Between 2005 and 2014, 19 patients 7 men (37%); mean (SD) age, 69.4 (14.5) years were treated with minimally invasive approach for degenerative mitral regurgitation and HOCM. Preoperative peak left ventricular outflow tract (LVOT) gradient was 66 (24) mm Hg. Severe mitral regurgitation was diagnosed in 16 cases (84%). New York Heart Association functional class III to IV heart failure was present in 13 patients (68%). RESULTS: Fifteen patients (79%) underwent mitral valve replacement, and four patients (21%) underwent mitral valve repair. Left ventricular outflow tract obstruction was corrected directly in all patients via the mitral valve with septal myectomy/myotomy, avoiding aortotomy in majority of the patients. No significant prolongation of extracorporeal circulation/aortic cross-clamping times was observed (P = 0.41 and P = 0.67, respectively) when compared with a similar population without HOCM. No iatrogenic ventricular septal defect developed in treated patients. No hospital mortality occurred. Resting LVOT gradient reduced at discharge to 13 (22) mm Hg (P = 0.025). CONCLUSIONS: Transmitral left ventricular septal myectomy in patients with degenerative mitral valve disease is quite a simple, feasible, and effective technique and does not require aortotomy in most cases. It can be performed with low early mortality and satisfactory resolution of LVOT obstruction in a minimally invasive setting.
Gilmanov et al. (Sun,) conducted a observational in Hypertrophic obstructive cardiomyopathy and intrinsic mitral valve disease (n=19). Minimally invasive transmitral septal myectomy and mitral valve repair/replacement vs. Preoperative baseline was evaluated on Resting LVOT gradient at discharge (p=0.025). Minimally invasive transmitral septal myectomy for HOCM and intrinsic mitral valve disease significantly reduced resting LVOT gradient from 66 mm Hg to 13 mm Hg at discharge (P=0.025).