Key result
Shallow septal myectomy with chordal cutting cuts outflow gradient ~86% and eliminates NYHA Class III/IV symptoms.
Why the study?
Anomalies of the mitral apparatus contribute to left ventricular outflow obstruction in hypertrophic cardiomyopathy, prompting the evaluation of shallow myectomy with transaortic mitral valve repair.
Does transaortic shallow septal myectomy combined with secondary mitral valve chordal cutting improve outflow obstruction and symptoms in patients with hypertrophic obstructive cardiomyopathy?
Cohort (n=83)
No
Does transaortic shallow septal myectomy combined with secondary mitral valve chordal cutting improve outflow obstruction and symptoms in patients with hypertrophic obstructive cardiomyopathy?
Transaortic shallow septal myectomy combined with secondary mitral valve chordal cutting effectively relieves left ventricular outflow obstruction and improves symptoms in patients with hypertrophic obstructive cardiomyopathy.
BACKGROUND: Anomalies of the mitral apparatus have been shown to contribute to left ventricular outflow obstruction in patients with hypertrophic cardiomyopathy (HCM). We report our 5-year single-center experience with a shallow myectomy procedure associated with transaortic mitral valve repair in a cohort of HCM patients. METHODS: We studied 83 consecutive patients who underwent surgical treatment of symptomatic left ventricular outflow obstruction. In all study patients, a transaortic shallow septal myectomy was performed. Fibrous or muscular structures connecting the papillary muscles to the septum or free wall were resected, and fibrotic secondary chordae of the anterior mitral valve were cut selectively. RESULTS: We report one death (1.2%) during hospitalization, no iatrogenic ventricular septal defects, and two (2.4%) mitral valve replacements. At discharge, no patients were in New York Heart Association (NYHA) Class III/IV, from 49 (59%) preoperatively. Mean maximal septal thickness decreased from 24 ± 6 to 16 ± 3 mm. Mean outflow gradient decreased from 93 ± 33 to 13 ± 11 mmHg. Grade 3 or 4 mitral regurgitation was noticed in one patient postoperatively, from 32 (39%) before surgery. CONCLUSIONS: Shallow septal myectomy associated with secondary mitral valve chordal cutting and papillary muscle mobilization provided excellent results offering adequate treatment of outflow obstruction.
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Dorobanţu et al. (2022) conducted a cohort in Hypertrophic Obstructive Cardiomyopathy (n=83). Transaortic shallow septal myectomy and cutting of secondary fibrotic mitral valve chordae vs. Preoperative baseline was evaluated on Mean outflow gradient (mmHg). Transaortic shallow septal myectomy with secondary mitral valve chordal cutting reduced mean outflow gradient from 93 to 13 mmHg and eliminated NYHA Class III/IV symptoms at discharge.
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