Combined septal myectomy and edge-to-edge MV repair significantly reduced peak LVOT gradient (82 to 16 mmHg), moderate or greater MR (84% to 5%), and SAM (96% to 0%) (p<0.001 for all).
Systematic Review (n=158)
Does combined septal myectomy and edge-to-edge mitral valve repair improve echocardiographic parameters and clinical outcomes in patients with obstructive hypertrophic cardiomyopathy?
Combined septal myectomy and edge-to-edge mitral valve repair effectively reduces LVOT gradient, systolic anterior motion, and mitral regurgitation with acceptable safety in patients with obstructive hypertrophic cardiomyopathy.
Absolute Event Rate: 16% vs 82%
p-value: p=<0.001
Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the mitral valve (MV) occurs in 70% of hypertrophic cardiomyopathy (HCM) patients. In individuals undergoing septal myectomy, concomitant MV surgery is considered for SAM with residual LVOT obstruction or mitral regurgitation (MR); however, the optimal approach remains debated. A literature search was performed in Pubmed, EMBASE, Ovid, and the Cochrane library of published articles through June 2021 reporting on combined septal myectomy and edge-to-edge MV repair for obstructive HCM. Continuous variables were weighted and compared using a student’s t-test, and categorical variables using a chi-square test with Yates correction. Six studies with 158 total patients were included. The mean follow-up was 2.8 ± 2.7 years. Compared with pre-operative values, there were significant reductions in the LV ejection fraction (69 ± 10 vs 59 ± 8%), peak LVOT gradient (82 ± 34 vs 16 ± 13 mmHg), prevalence of moderate or greater MR (84 vs 5 %), and presence of SAM (96% vs 0) (p < 0.001 for all). There was no change in LV internal diastolic diameter (4.2 ± 1.3 vs 4.4 ± 1.5 cm, p = 0.32). There were 2 (1%) operative mortalities. At follow-up, the survival rate was 97%, there were 3 (2%) re-operative MV replacements, 4 (3%) patients remained in New York Heart Association functional class III/IV, and 8 (6%) required permanent pacemaker implantation. In conclusion, combined septal myectomy and edge-to-edge MV repair is a safe and effective treatment strategy in carefully selected patients requiring surgical HCM management.
Mihos et al. (Wed,) conducted a systematic review in obstructive hypertrophic cardiomyopathy (n=158). combined septal myectomy and edge-to-edge MV repair vs. pre-operative values was evaluated on peak LVOT gradient (mmHg) (p=<0.001). Combined septal myectomy and edge-to-edge MV repair significantly reduced peak LVOT gradient (82 to 16 mmHg), moderate or greater MR (84% to 5%), and SAM (96% to 0%) (p<0.001 for all).
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