Septal Myectomy With Vs Without Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: A Prospective Randomized Study

Bogachev-Prokophiev, Alexander; Afanasyev, Alexander; Железнев, С. И.; Pivkin, Alexey; Sharifulin, Ravil; Козьмин, Д. Ю.; Караськов, А. М.

doi:10.1053/j.semtcvs.2019.01.011

Cited by 15 publications

(15 citation statements)

References 20 publications

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“…In our single-center experience, to improve SM outcomes, we used the classic Morrow procedure to perform extended myectomy (adopted from the Schaff group, 6 ) from adding MVR to non-MVR, conducted several pilot studies assessing MV repair, including subvalvular apparatus intervention (adapted from Ferrazzi et all 7 ) and edge-to-edge repair. 11,26–28 In 2019, a group from Monza 29 described a novel role of preoperative cardiac magnetic resonance (CMR), which could render SM more accessible to surgeons by defining areas of marked septal thinning. We adopted this technique, and since 2020, we have been screening most patients using CMR.…”

Section: Resultsmentioning

confidence: 99%

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Afanasyev

Bogachev-Prokophiev

Железнев

et al. 2021

Asian Cardiovasc Thorac Ann

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Background We aimed to evaluate early outcomes of septal myectomy in patients with hypertrophic cardiomyopathy. Methods We retrospectively analyzed data collected over a 9-year period from 583 patients who underwent septal myectomy for hypertrophic cardiomyopathy at our institution. Results The mean age was 55.7 ± 13.1 years, and 338 (58%) patients were in New York Heart Association class III or IV. There were 11 (1.9%) early deaths, including 3 (0.5%) intraoperative deaths. Early mortality was lowest after isolated septal myectomy (0.8%) and highest after concomitant mitral valve replacement (6.1%). There were 4 (0.7%) and 9 (1.5%) patients with left ventricular wall rupture and ventricular septal defect, respectively, after myectomy. New pacemaker implantation caused by atrioventricular disturbances was required in 29 (5.0%) patients, and was associated with previous alcohol septal ablation (odds ratio 3.34, 95% confidence interval 1.02–11.0, P = 0.047). Left ventricular wall rupture, intraoperative residual (15.5% moderate, 0.3% severe) mitral regurgitation, and pre-discharge residual outflow tract gradient >30 mm Hg (4.6%) occurrences were surgeon-dependent. Conclusions The early results are consistent with example targets reported in the 2020 American College of Cardiology/American Heart Association guidelines for septal reduction therapy outcomes. Septal myectomy safety and efficacy are surgeon-dependent. Previous alcohol septal ablation increases the risk of permanent pacemaker implantation due to postoperative complete atrioventricular block. Therefore, continuous education, mentoring, and learning by doing may play an important role in achieving reasonable septal myectomy safety and efficacy.

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Section: Resultsmentioning

confidence: 99%

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Afanasyev

Bogachev-Prokophiev

Железнев

et al. 2021

Asian Cardiovasc Thorac Ann

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“…11 In addition, the efficacy of second chorda resection 12 or the mitral anterior leaflet plication 8 was reported, while the effectiveness of appropriate intervention for the mitral complex to control postoperative MR has also been reported. 13 In this study, we performed transapical septal myectomy in HCM patients with complicated anatomical features, and were able to relieve obstruction safely and reliably from early postoperative period. Furthermore, symptoms of HCM and MR also improved over the mid-term.…”

Section: Discussionmentioning

confidence: 97%

Transapical septal myectomy for hypertrophic cardiomyopathy, an experience from Japan

Shimizu

Takanashi

Takamisawa

et al. 2022

Asian Cardiovasc Thorac Ann

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Background While there are a variety of surgical options for hypertrophic cardiomyopathy, there are small number of reports of transapical septal myectomy. Furthermore, the characteristics and incidence of anomalous structures in the left ventricle in hypertrophic cardiomyopathy patients which can be identified with imaging studies are not clear. Methods We studied hypertrophic cardiomyopathy patients who underwent transapical septal myectomy from July 2013 to December 2019. We evaluated the frequency and characteristics of anomalous structures in the left ventricle which had been identified by preoperative examinations and studied their postoperative results. Results A total of 59 patients was included. The median age was 40 years. Sixteen patients (27.4%) were in New York Heart Association Functional Classification III or IV. The median peak intraventricular gradient at rest was 65 mmHg. By preoperative imaging studies, anomalous structures were detected in 56 cases (94.9%), of which 88% were successfully resected with myectomy. There were two perioperative deaths, while one late death caused by acute myocardial infarction occurred. The estimated 5-year survival rate was 95%. The intraventricular gradient had significantly decreased at the time of discharge, and no reoperation for recurrent obstruction was conducted. The left ventricular ejection fraction had significantly decreased after the operation, was however within the normal range. Left atrium volume index and tricuspid regurgitant velocity significantly improved. Conclusions Patients receiving transapical septal myectomy restored good hemodynamics from early postoperative period and showed improved subjective symptoms and good mid-term results. With multimodal imaging studies, we could accurately identify anomalous structures in hypertrophic cardiomyopathy patients and reliably treat them by transapical septal myectomy.

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“…Определяющим фактором для достижения хороших результатов СМЭ/РМЭ и САА является опыт Центров, который должен измеряться более чем 50 процедурами, выполняемыми в год, и более чем 20 процедурами, выполняемыми хирургом или интервенционным кардиологом. Редукция МЖП должна выполняться опытным специалистом, работающим в мультидисциплинарной команде экспертов в лечении ГКМП [3,4,106,213,320,321,[378][379][380][381][382][383][384][385][386].…”

Section: редукция мжпunclassified

2020 Clinical practice guidelines for Hypertrophic cardiomyopathy

Габрусенко¹,

Гудкова²,

Козиолова³

et al. 2021

Russ J Cardiol

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Russian Society of Cardiology (RSC)With the participation: Russian Association of Cardiovascular SurgeonsEndorsed by: Research and Practical Council of the Ministry of Health of the Russian Federation Task Force: Gabrusenko S.A. (Chairman), Gudkova A.Ya.* (Chairman), Koziolova N.A. (Chairman), Alexandrova S.A., Berseneva M.I., Gordeev M.L., Dzemeshkevich S.L., Zaklyazminskaya E.V., Irtyuga O.B., Kaplunova V.Yu., Kostareva A.A., Krutikov A.N., Malenkov D.A., Novikova T.N., Saidova M.A., Sanakoev M.K., Stukalova O.V.

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Septal Myectomy With Vs Without Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: A Prospective Randomized Study

Cited by 15 publications

References 20 publications

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy

Transapical septal myectomy for hypertrophic cardiomyopathy, an experience from Japan

2020 Clinical practice guidelines for Hypertrophic cardiomyopathy

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