Key result
Subvalvular management during septal myectomy is linked to ~27% lower LVOT gradient and abolished SAM.
Why the study?
The choice between concomitant mitral valve management versus septal myectomy alone remains controversial in hypertrophic obstructive cardiomyopathy with severe mitral regurgitation.
Does concomitant mitral subvalvular management during septal myectomy improve mitral regurgitation and reduce outflow tract gradients in HOCM patients with severe MR without intrinsic mitral valve disease?
Observational (n=146)
No
Does concomitant mitral subvalvular management during septal myectomy improve mitral regurgitation and reduce outflow tract gradients in HOCM patients with severe MR without intrinsic mitral valve disease?
Absolute Event Rate: 8.8% vs 12.1%
p-value: p=0.006
Concomitant mitral subvalvular procedures during septal myectomy in HOCM patients with severe MR without intrinsic MV disease safely reduces SAM incidence and LVOT gradients compared to myectomy alone.
May support subvalvular management in selected HOCM; hypothesis-generating and should not yet change practice without RCTs.
Background: Hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral regurgitation (MR) remains controversial for the choice of the concomitant mitral valve (MV) management versus septal myectomy alone. The impacts of different surgical strategies (concomitant mitral subvalvular procedures versus myectomy alone) on one-year results of surgical treatment of HOCM with grade 3 to 4+ MR without intrinsic MV disease were evaluated in this single-center, retrospective observational study. Methods: A total of 146 eligible patients were retrospectively screened into a combined group (n = 40) and an alone group (n = 106), depending on whether they underwent transaortic mitral subvalvular procedures. Perioperative outcomes were collected, and results at 1-year following surgery were compared. Results: Surgical mortality did not differ (0 for combined group vs. 0.9% for alone group, p = 0.538). Six patients (5.0% vs. 3.8%, p = 0.666) developed postoperative complete atrioventricular node block with permanent pacemaker implantation. No death or reoperation was recorded during a median follow-up of 18 months. At 1-year following surgery, (1) the provoked MR severity decreased from baseline in both groups with a significant difference between groups [1.0 (0–1.0) vs. 1.0 (1.0–1.3), p < 0.001]; (2) systolic anterior motion (SAM) was observed in 10 patients (0 vs. 10 in the alone group, p = 0.043); (3) the provoked gradient was also significantly lower than baseline value for each group, with a significant difference between the two groups (8.8 ± 4.3 mmHg vs. 12.1 ± 6.7 mmHg, p = 0.006); and (4) New York Heart Association class decreased from baseline value for each group (p < 0.001). Conclusions: In HOCM patients with grade 3 to 4+ MR without intrinsic MV disease, mitral subvalvular management during septal myectomy may be associated with a low incidence of SAM, improved MR, and a lower outflow tract gradient in comparison with septal myectomy alone.
No takes yet. Share an insight, caveat, or question.
Liu et al. (2022) conducted an observational in Hypertrophic Obstructive Cardiomyopathy with grade 3 to 4+ Mitral Regurgitation without Intrinsic Mitral Valve Disease (n=146). Septal myectomy with concomitant mitral subvalvular procedures vs. Septal myectomy alone was evaluated on Provoked LVOT gradient at 1 year (mmHg) (p=0.006). Concomitant mitral subvalvular management during septal myectomy significantly reduced the provoked LVOT gradient (8.8 vs 12.1 mmHg) and abolished systolic anterior motion compared to myectomy alone in patients with hypertrophic obstructive cardiomyopathy.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: