Hypertrophic Cardiomyopathy With Elongated Mitral Valve Leaflets: Clinical Characteristics and Surgical Results

IF 1.3 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Cardiac Surgery Pub Date : 2024-10-29 DOI:10.1155/2024/7078246

Xianying Liu, Daniel McGrath, Kelly Ohlrich, Frederick Y. Chen, Lawrence S. Lee, Michael Robich

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Abstract

Background: Hypertrophic cardiomyopathy (HCM) is commonly associated with mitral valve pathology. A large majority of patients with HCM have elongated anterior and posterior mitral leaflets. There remains debate regarding the necessity and role of concomitant mitral valve surgery at the time of septal myectomy. We aimed to describe the characteristics and share our surgical experiences with this specific group of patients.

Methods: This retrospective single-center study investigates adult patients with HCM, with or without elongated mitral valve leaflets (MVLs), who underwent elective septal myectomy with or without concomitant mitral valve intervention, between January 1, 2016, and June 30, 2020. Clinical data were obtained from institutional medical records as well as the Society of Thoracic Surgeons data registry. The clinical characteristics and in-hospital surgical outcomes were compared between patients with an elongated MVL and those without.

Results: In total, 379 patients underwent septal myectomy, and 22 patients with intrinsic mitral valve disease were excluded. In addition, 23 patients were excluded due to missing data. Of the remaining 334 patients, 131 (39.2%) had elongated MVL and concomitant MVL plication. Patients with elongated MVL had higher rates of preoperative mitral valve systolic anterior motion (SAM) (94.7% vs. 86.7%, p = 0.019) and higher preoperative provoked left ventricular outflow tract gradient (LVOTG) (134.5 mmHg versus 125.3 mmHg, p = 0.046). Post septal myectomy and mitral valve plication, they had lower rates of postoperative residual mitral regurgitation (3.8% vs. 12.8%, p = 0.006), comparable rates of residual SAM (28.2% vs. 31.5%, p = 0.524), postoperative provoked LVOTG (15.4 mmHg vs. 14.0 mmHg, p = 0.317), 30-day major adverse cardiopulmonary events (2.3% vs. 3.9%, p = 0.409), and mortality (0% vs. 1.0%, p = 0.255).

Conclusions: Elongated MVLs contribute more significantly to dynamic LVOT obstruction, as evidenced during provocative testing. Concomitant mitral valve intervention during septal myectomy can be performed safely and may provide an effective strategy to resolve SAM and stress-induced LVOTG.

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肥厚型心肌病伴二尖瓣瓣叶延长：临床特征和手术结果

背景：肥厚型心肌病（HCM）通常与二尖瓣病变有关。大多数 HCM 患者的二尖瓣前叶和后叶都被拉长。关于在进行室间隔瓣膜切除术的同时进行二尖瓣手术的必要性和作用仍存在争议。我们旨在描述这类特殊患者的特征并分享我们的手术经验。方法：这项回顾性单中心研究调查了在 2016 年 1 月 1 日至 2020 年 6 月 30 日期间接受或不接受二尖瓣介入治疗的选择性室间隔缺损切除术的成年 HCM 患者，无论患者是否伴有二尖瓣叶变长（MVL）。临床数据来自医疗机构的病历以及胸外科医师协会的数据登记。比较了MVL拉长患者和未拉长患者的临床特征和院内手术结果。结果：共有 379 名患者接受了室间隔肌层切除术，其中有 22 名患有二尖瓣固有疾病的患者被排除在外。此外，23 名患者因数据缺失而被排除。在剩余的 334 例患者中，131 例（39.2%）患者的 MVL 被拉长，并同时进行了 MVL 植入术。MVL 拉长的患者术前二尖瓣收缩前运动（SAM）率较高（94.7% 对 86.7%，P = 0.019），术前诱发的左室流出道梯度（LVOTG）较高（134.5 mmHg 对 125.3 mmHg，P = 0.046）。室间隔肌肉切除术和二尖瓣成形术后，他们术后残余二尖瓣反流的比例较低（3.8% 对 12.8%，P = 0.006），残余 SAM 的比例相当（28.2% 对 31.5%，P = 0.524）。5%，p = 0.524）、术后诱发 LVOTG（15.4 mmHg vs. 14.0 mmHg，p = 0.317）、30 天主要不良心肺事件（2.3% vs. 3.9%，p = 0.409）和死亡率（0% vs. 1.0%，p = 0.255）相当。结论激振试验证明，拉长的 MVL 对动态左心室出口梗阻的影响更大。在进行室间隔肌肉切除术时，可以安全地同时进行二尖瓣介入治疗，这可能是解决 SAM 和压力诱发的 LVOTG 的有效策略。

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来源期刊

Journal of Cardiac Surgery 医学-外科

CiteScore

2.90

自引率

12.50%

发文量

976

审稿时长

3-8 weeks

期刊介绍： Journal of Cardiac Surgery (JCS) is a peer-reviewed journal devoted to contemporary surgical treatment of cardiac disease. Renown for its detailed "how to" methods, JCS''s well-illustrated, concise technical articles, critical reviews and commentaries are highly valued by dedicated readers worldwide. With Editor-in-Chief Harold Lazar, MD and an internationally prominent editorial board, JCS continues its 20-year history as an important professional resource. Editorial coverage includes biologic support, mechanical cardiac assist and/or replacement and surgical techniques, and features current material on topics such as OPCAB surgery, stented and stentless valves, endovascular stent placement, atrial fibrillation, transplantation, percutaneous valve repair/replacement, left ventricular restoration surgery, immunobiology, and bridges to transplant and recovery. In addition, special sections (Images in Cardiac Surgery, Cardiac Regeneration) and historical reviews stimulate reader interest. The journal also routinely publishes proceedings of important international symposia in a timely manner.