Surgical Outcomes of Septal Myectomy With and Without Mitral Valve Surgeries in Hypertrophic Cardiomyopathy: a National Propensity-Matched Analysis (2005 to 2020)

Faisaluddin, Mohammed; Ahmed, Asmaa; Patel, Harsh; Thakkar, Samarthkumar; Patel, Bhavin; Balasubramanian, Senthil; Feitell, Scott C.; Shekar, Prem; Rowin, Ethan; Maron, Martin; Ganatra, Sarju; Dani, Sourbha S.

doi:10.1016/j.amjcard.2023.07.150

The American Journal of Cardiology

2023

DOI: 10.1016/j.amjcard.2023.07.150

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Surgical Outcomes of Septal Myectomy With and Without Mitral Valve Surgeries in Hypertrophic Cardiomyopathy: a National Propensity-Matched Analysis (2005 to 2020)

Mohammed Faisaluddin,

Asmaa Ahmed,

Harsh Patel

et al.

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Cited by 3 publications

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Muscling in on the Mitral Valve

Levi,

Meerkin

2023

Canadian Journal of Cardiology

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Muscling in on the Mitral Valve

Levi,

Meerkin

2023

Canadian Journal of Cardiology

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Systolic anterior motion-mediated mitral regurgitation and surgical management in hypertrophic obstructive cardiomyopathy

Wang,

Zhu,

Quintana

et al. 2024

European Journal of Cardio-Thoracic Surgery

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Mitral regurgitation (MR) mediated by systolic anterior motion (SAM) is a typical manifestation in patients with hypertrophic obstructive cardiomyopathy (HOCM). Although septal myectomy (SM) is currently the preferred treatment for patients with drug-refractory HOCM. Surgical management of associated MR remains controversial. Whether SM alone or additional valve procedures are required to correct significant MR depends largely on each individual pathophysiology. For intervention purposes, it is important to identify the real SAM-mediated MR and clarify the mitral structural abnormalities, as well as the other conditions, which may alert mitral valve (MV) competence. As a first-line imaging modality in the management of hypertrophic cardiomyopathy, echocardiography could provide crucial information for surgical decision-making. In this article, we focus on elucidating the typical echocardiographic features of SAM-mediated MR and offer the assessment process to determine other contributors to obstruction and MR. Additionally, guidance for surgical decision-making for MR in HOCM patients is been discussed.

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Outcomes of Concomitant Mitral Intervention in Hypertrophic Obstructive Cardiomyopathy Surgery?: A Systematic Review and Meta-Analysis of Contemporary Evidence

Domondon,

de Guzman,

Bruno

et al. 2024

Cardiology in Review

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The 2020 American Heart Association Guidelines advise not to perform mitral valve replacement (MVR) during septal myectomy (SM) to alleviate outflow obstruction. This study aims to review outcomes after concomitant mitral valve (MV) intervention versus SM alone. We conducted a comprehensive literature search across Embase, PubMed, and Scopus. Studies published up to June 15, 2024 were considered. We included studies that compared SM alone to concomitant MV repair or replacement. Subgroup analyses based on MV intervention were performed. Seven studies met our criteria, including 1 randomized and 6 observational studies. The total sample size was 17,565 patients with hypertrophic cardiomyopathy (11,849 SM, 2303 SM + MVR, and 3390 SM + MV repair). Patients who underwent SM + MV intervention had more pronounced preoperative MV regurgitation. SM + MVR was associated with significantly higher early mortality [risk ratio (RR): 2.85, 95% confidence interval (CI): 2.37–3.43, P < 0.00001, I² = 0%]. However, there was no difference in early mortality in patients who underwent SM + MV repair compared with SM alone (RR: 1.14, 95% CI: 0.88–1.49, P = 0.33, I² = 0%). Thirty days systolic anterior motion was significantly lower in patients who underwent SM + MV repair compared with SM alone (RR: 0.15, 95%CI: 0.05–0.45, P = 0.0007). Peak pressure left ventricular outflow tract gradient was significantly lower in the SM + MV repair group compared with SM alone (mean difference: −3.47, 95% CI: −5.55 to −1.39, P = 0.001). Current observational evidence suggests an increased risk of in-patient mortality in patients who underwent SM + MVR. SM + MV repair did not affect early mortality but was linked to improved outcomes. Future comprehensive and matched studies are warranted.

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Surgical Outcomes of Septal Myectomy With and Without Mitral Valve Surgeries in Hypertrophic Cardiomyopathy: a National Propensity-Matched Analysis (2005 to 2020)

Cited by 3 publications

References 9 publications

Muscling in on the Mitral Valve

Muscling in on the Mitral Valve

Systolic anterior motion-mediated mitral regurgitation and surgical management in hypertrophic obstructive cardiomyopathy

Outcomes of Concomitant Mitral Intervention in Hypertrophic Obstructive Cardiomyopathy Surgery?: A Systematic Review and Meta-Analysis of Contemporary Evidence

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