Transaortic shallow septal myectomy with mitral valve repair in treatment of hypertrophic obstructive cardiomyopathy with severe interstitial fibrosis ： compared to extended Morrow procedure

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertrophic obstructive cardiomyopathy (HOCM) (n=36). Intervention: Transaortic shallow septal myectomy with mitral valve repair vs. Extended Morrow procedure. Primary outcome: Relief of left ventricular outflow tract obstruction and reduction of mitral regurgitation.

Yi Guo; Huangjie Li; Z H Wu; Yuyin Duan; Yanhai Meng; Yuling An; Lei Yan

doi:10.21203/rs.3.rs-2162759/v1

December 13, 2022Open Access

Transaortic shallow septal myectomy with mitral valve repair in treatment of hypertrophic obstructive cardiomyopathy with severe interstitial fibrosis ： compared to extended Morrow procedure

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Key result

Shallow septal myectomy with MV repair relieves LVOTO and MR without increasing arrhythmias versus extended Morrow.

n=36

Why the study?

Comparative outcomes of transaortic shallow septal myectomy with mitral valve repair versus extended Morrow procedure in hypertrophic obstructive cardiomyopathy with severe interstitial fibrosis were lacking.

Does transaortic shallow septal myectomy with concomitant mitral valvuloplasty effectively relieve LVOTO and MR without increasing postoperative arrhythmias compared to the extended Morrow procedure in HOCM patients with severe interstitial fibrosis?

Study Design

Type

Cohort (n=36)

Multicenter

No

Structured PICO

Does transaortic shallow septal myectomy with concomitant mitral valvuloplasty effectively relieve LVOTO and MR without increasing postoperative arrhythmias compared to the extended Morrow procedure in HOCM patients with severe interstitial fibrosis?

P

Population

36 consecutive patients diagnosed with hypertrophic obstructive cardiomyopathy (HOCM), mean age 50 years, predominantly male. Indications for surgery: LVOT PG ≥50mmHg at rest or during physiological stimulation, and drug-resistant symptoms despite maximum tolerated dose of beta-blockers and calcium channel blockers for at least 6 months. Exclusions: older than 70 years of age, additional risk of pump cardiac surgery.

I

Intervention

Transaortic shallow septal myectomy (removal of about one-third of IVS thickness) concomitant with mitral valvuloplasty (MVP) due to intrinsic abnormalities of the MV leaflet and/or subvalvular apparatus (n=13).

C

Comparator

Extended Morrow procedure alone (septal myectomy extending to the apex of LV) without any intrinsic MV abnormalities, for patients with Grade 1-4 MR due to systolic anterior motion (n=23).

O

Outcome

Relief of left ventricular outflow tract obstruction (LVOT PG), decrease in mitral regurgitation (MR), and incidence of postoperative arrhythmia at 6-51 months follow-up.surrogate

Shallow septal myectomy combined with mitral valve repair provides excellent relief of LVOTO and MR without increasing arrhythmia risk in HOCM patients with severe interstitial fibrosis and intrinsic mitral valve abnormalities.

Limitations

Single center retrospective study
Small sample size
Short follow-up time
Simple statistical analysis
Limited ability to confirm ventricular arrhythmias or emerging atrial fibrillation due to small cohort
Simple statistical analysis restricted by sample size

Implication

May support shallow myectomy with mitral repair for LVOTO/MR in fibrotic HOCM; hypothesis-generating, needs randomized confirmation.

Abstract

BACKGROUND: There is lack of outcomes of transaortic shallow septal myectomy with mitral valve(MV) repair comparing with extended Morrow procedure in treatment of hypertrophic obstructive cardiomyopathy (HOCM) with severe interstitial fibrosis. OBJECTIVES: We report a 4-year single-center experience with transaortic shallow septal myectomy in combination with MV repair and compare it with extended Morrow surgery in a cohort of HOCM patients with severe interstitial fibrosis. METHODS: 36 patients who received surgery have been enrolled in current study. Their perioperative characteristics with echocardiographic results, myocardial histopathology and follow up outcomes had been graded and analyzed. We included two groups:13 patients who received shallow septal myectomy concomitant with mitral valvuloplasty (MVP) due to the intrinsic abnormalities of MV apparatus (Shallow septal myectomy + MVP group), and 23 patients who only received extended Morrow procedure without any intrinsic MV abnormalities (Extended Morrow group). RESULTS: Preoperative results revealed that left ventricular end-diastolic dimension (LVEDD) (46.9±1.41mm vs. 11.4±2.17mm, p ＜0.05), posterior wall thickness (PWT) (13.3±2.66mm vs. 11.4±2.17mm, p ＜0.05), left ventricular mass (LVM) (440.2±78.9g Vs. 310.9±127.6g, p ＜0.05), left ventricular mass index (LVMI) (231.7±75.39g/m 2 Vs. 180.2±65.07g/m 2 , p ＜0.05 ) and late gadolinium enhancement (LGE) (72.73% Vs. 27.27%, p ＜0.01 ) had showed the significant difference between the two group. In the myocardial histopathological evaluation, more severe interstitial fibrosis of the resected myocardium in Shallow septal myectomy + MVP group had showed statistical significant difference compared with Extended Morrow group ( p ＜0.05). Shallow septal myectomy + MVP procedure sufficiently release left ventricular outflow tract obstruction(LVOTO) and decrease mitral regurgitation (MR) with no increase of postoperative arrhythmia compared with Extended Morrow surgery. CONCLUSIONS : Shallow septal myectomy associated with concomitant MVP provided excellent results offering adequate treatment of LVOTO with no increase of postoperative arrhythmia complication for HOCM patients with severe interstitial fibrosis.

Discussion

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Cite This Study

Guo et al. (2022) conducted a cohort in Hypertrophic obstructive cardiomyopathy (HOCM) (n=36). Transaortic shallow septal myectomy with mitral valve repair vs. Extended Morrow procedure was evaluated on Relief of left ventricular outflow tract obstruction and reduction of mitral regurgitation. Transaortic shallow septal myectomy combined with mitral valve repair sufficiently relieved left ventricular outflow tract obstruction and decreased mitral regurgitation without increasing postoperative arrhythmias compared to the extended Morrow procedure.

synapsesocial.com/papers/6a1605fc58f24b40adb563ac https://doi.org/10.21203/rs.3.rs-2162759/v1

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Transaortic shallow septal myectomy with mitral valve repair in treatment of hypertrophic obstructive cardiomyopathy with severe interstitial fibrosis ： compared to extended Morrow procedure

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

Transaortic shallow septal myectomy with mitral valve repair in treatment of hypertrophic obstructive cardiomyopathy with severe interstitial fibrosis ： compared to extended Morrow procedure

Study Design

Structured PICO

Limitations

Implication

Abstract

Discussion

Cite This Study

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