Key result
Adding mitral subvalvular procedures to myectomy is linked to ~11% lower outflow tract gradients.
Why the study?
Few studies have characterized HOCM patients without intrinsic mitral valve diseases undergoing mitral subvalvular procedures during myectomy, and data on surgical results are limited.
Does myectomy plus mitral subvalvular procedures improve outflow tract gradients and reduce systolic anterior motion compared to myectomy alone in HOCM patients without intrinsic mitral valve disease?
Cohort (n=181)
No
Does myectomy plus mitral subvalvular procedures improve outflow tract gradients and reduce systolic anterior motion compared to myectomy alone in HOCM patients without intrinsic mitral valve disease?
Odds Ratio: 0.887 (95% CI 0.612–0.917)
In HOCM patients without intrinsic mitral valve disease, adding mitral subvalvular procedures to myectomy is safe and more effectively reduces outflow tract gradients and systolic anterior motion compared to myectomy alone.
May support combined myectomy plus subvalvular procedures in HOCM; leaves open need for randomized confirmation before practice change.
BACKGROUND: Mitral subvalvular procedures have acquired a major role during hypertrophic obstructive cardiomyopathy (HOCM) surgery. However, few studies have focused on characterizing the clinical feature of HOCM patients without intrinsic mitral valve (MV) diseases undergoing mitral subvalvular procedures in addition to myectomy. Additionally, scant data about the results of mitral subvalvular procedures during HOCM surgery are available. This single-center study aims to characterize the clinical feature and surgical results of HOCM patients without intrinsic MV diseases undergoing mitral subvalvular procedures in addition to myectomy in comparison with those receiving myectomy alone. METHODS: Among 181 eligible patients, 50 (27.6%) patients undergoing myectomy plus mitral subvalvular procedures were entered into the combined group, and the remaining 131 patients receiving myectomy alone were included in the alone group. Baseline and surgical characteristics were investigated, and surgical results were compared. Septal thickness was independently associated with combined procedures in multivariable logistic regression analysis (OR = 0.887, 95% CI 0.612-0.917). No surgical death or iatrogenic septal perforation occurred in the combined group. Two (6.5%) patients in the combined group developed complete atrioventricular block and required permanent pacemaker implantation. During a median follow-up of 10 months, no deaths or reoperations were observed with the symptom of relief and NYHA class I or II in either group. Patients in the combined group as compared to the alone group had lower outflow tract gradients and a lower incidence of residual systolic anterior motion (SAM) syndrome. CONCLUSIONS: For HOCM patients without intrinsic MV diseases who are scheduled for surgery, a less pronounced septal hypertrophy may be closely associated with myectomy with concomitant mitral subvalvular procedures instead of myectomy alone. Mitral subvalvular procedures during myectomy are safe and allow the reduction of outflow tract gradients and freedom from SAM more effectively in comparison with myectomy alone.
No takes yet. Share an insight, caveat, or question.
Ji et al. (2020) conducted a cohort in Hypertrophic obstructive cardiomyopathy without intrinsic mitral valve diseases (n=181). Myectomy with mitral subvalvular procedures vs. Myectomy alone was evaluated on Receipt of combined myectomy and mitral subvalvular procedures (predicted by septal thickness) (OR 0.887, 95% CI 0.612-0.917). Myectomy with mitral subvalvular procedures was associated with less pronounced septal thickness (OR 0.887; 95% CI 0.612-0.917) and yielded lower outflow tract gradients compared to myectomy alone.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: