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A systematic review and pooled analysis of septal myectomy and edge-to-edge mitral valve repair in obstructive hypertrophic cardiomyopathy

Reviews in cardiovascular medicine, 2021-12, Vol.22 (4), p.1471-1477 [Peer Reviewed Journal]

2021 The Author(s). Published by IMR Press. ;ISSN: 1530-6550 ;ISSN: 2153-8174 ;EISSN: 2153-8174 ;DOI: 10.31083/j.rcm2204151 ;PMID: 34957786

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Title:
A systematic review and pooled analysis of septal myectomy and edge-to-edge mitral valve repair in obstructive hypertrophic cardiomyopathy
Author: Mihos, Christos G ; Escolar, Esteban ; Fernandez, Rafle ; Nappi, Francesco
Subjects: alfieri stitch ; Cardiac Surgical Procedures - adverse effects ; Cardiomyopathy, Hypertrophic - complications ; Cardiomyopathy, Hypertrophic - diagnostic imaging ; Cardiomyopathy, Hypertrophic - surgery ; edge-to-edge repair ; Heart Septum - surgery ; hocm ; Humans ; hypertrophic cardiomyopathy ; mitral regurgitation ; Mitral Valve - diagnostic imaging ; Mitral Valve - surgery ; Mitral Valve Insufficiency - diagnostic imaging ; Mitral Valve Insufficiency - surgery ; mitral valve repair ; systolic anterior motion ; Treatment Outcome
Is Part Of: Reviews in cardiovascular medicine, 2021-12, Vol.22 (4), p.1471-1477
Description: 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 -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) ( < 0.001 for all). There was no change in LV internal diastolic diameter (4.2 ± 1.3 vs 4.4 ± 1.5 cm, = 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.
Publisher: Singapore: IMR Press
Language: English
Identifier: ISSN: 1530-6550
ISSN: 2153-8174
EISSN: 2153-8174
DOI: 10.31083/j.rcm2204151
PMID: 34957786
Source: MEDLINE
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A systematic review and pooled analysis of septal myectomy and edge-to-edge mitral valve repair in obstructive hypertrophic cardiomyopathy

2021 The Author(s). Published by IMR Press. ;ISSN: 1530-6550 ;ISSN: 2153-8174 ;EISSN: 2153-8174 ;DOI: 10.31083/j.rcm2204151 ;PMID: 34957786

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