Morrow myoseptectomy without correction of moderate and severe mitral insufficiency
Abstract
Aim: The aim of this work is to analyze the clinical and echocardiographic results of Morrow myoseptectomy without correction of moderate and severe mitral insufficiency; to identify risk factors for ≥2+ degree of residual mitral insufficiency after myoseptectomy.
Material and Methods: From January 2019 to September 2023, 200 patients underwent Morrow resection of hypertrophied LVP at our center. Exclusion criteria for the study were:
1) age less than 18 years;
2) need for coronary bypass;
3) organic lesions of aortic and mitral valves requiring surgical correction.
Thus, 115 patients who underwent isolated intervention were included in the study. Two groups were formed: group 1 (n=36) - patients with no or mild MI; group 2 (n=79) - patients with moderate and severe MI.
About the Authors
E. E. KobzevRussian Federation
Kobzev Evgeny Evgenyevich, doctor - cardiovascular surgeon, head of department
Khabarovsk
N. P. Sosnina
Russian Federation
Sosnina Nina Petrovna - cardiologist
Khabarovsk
E. V. Rosseikin
Russian Federation
Rosseikin Evgeny Vladimirovich, MD, Chief Physician
Khabarovsk
References
1. Arbelo E, Protonotarios A, Gimeno JR, Arbustini E, Barriales-Villa R, Basso C, Bezzina CR, Biagini E, Blom NA, de Boer RA, De Winter T, Elliott PM, Flather M, Garcia-Pavia P, Haugaa KH, Ingles J, Jurcut RO, Klaassen S, Limongelli G, Loeys B, Mogensen J, Olivotto I, Pantazis A, Sharma S, Van Tintelen JP, Ware JS, Kaski JP; ESC Scientific Document Group. 2023 ESC Guidelines for the management of cardiomyopathies. Eur Heart J. 2023 Oct 1;44(37):3503-3626. doi: 10.1093/eurheartj/ehad194. PMID: 37622657.
2. Ommen SR, Mital S, Burke MA, Day SM, Deswal A, Elliott P, Evanovich LL, Hung J, Joglar JA, Kantor P, Kimmelstiel C, Kittleson M, Link MS, Maron MS, Martinez MW, Miyake CY, Schaff HV, Semsarian C, Sorajja P. 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients With Hypertrophic Cardiomyopathy: Executive Summary: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020 Dec 22;142(25):e533-e557. doi: 10.1161/CIR.0000000000000938. Epub 2020 Nov 20. PMID: 33215938.
3. Maron BJ, Dearani JA, Smedira NG, Schaff HV, Wang S, Rastegar H, Ralph-Edwards A, Ferrazzi P, Swistel D, Shemin RJ, Quintana E, Bannon PG, Shekar PS, Desai M, Roberts WC, Lever HM, Adler A, Rakowski H, Spirito P, Nishimura RA, Ommen SR, Sherrid MV, Rowin EJ, Maron MS. Ventricular Septal Myectomy for Obstructive Hypertrophic Cardiomyopathy (Analysis Spanning 60 Years Of Practice): AJC Expert Panel. Am J Cardiol. 2022 Oct 1;180:124-139. doi: 10.1016/j.amjcard.2022.06.007. Epub 2022 Aug 12. PMID: 35965115.
4. Hong JH, Nguyen A, Schaff HV. Management of the mitral valve in patients with obstructive hypertrophic cardiomyopathy. Indian J Thorac Cardiovasc Surg. 2020 Jan;36(Suppl 1):34-43. doi: 10.1007/s12055-019-00817-y. Epub 2019 May 7. PMID: 33061183; PMCID: PMC7525927.
5. Nguyen A, Schaff HV, Nishimura RA, Dearani JA, Geske JB, Lahr BD, Ommen SR. Does septal thickness influence outcome of myectomy for hypertrophic obstructive cardiomyopathy? Eur J Cardiothorac Surg. 2018 Mar 1;53(3):582-589. doi: 10.1093/ejcts/ezx398. PMID: 29182736.
6. Nguyen A. Septal myectomy in patients with hypertrophic cardiomyopathy with lesser septal thickness-mitral valve repair is not necessary. Eur J Cardiothorac Surg. 2021 Jul 30;60(2):252. doi: 10.1093/ejcts/ezab226. PMID: 34254139.
7. Desai MY, Bhonsale A, Smedira NG et al. , Naji P, Thamilarasan M, Lytle BW, Lever HM. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction. Circulation. 2013 Jul 16;128(3):209-16. doi: 10.1161/CIRCULATIONAHA.112.000849. Epub 2013 Jun 14. PMID: 23770748.
8. Ferrazzi P, Spirito P, Iacovoni A, Calabrese A, Migliorati K, Simon C, Pentiricci S, Poggio D, Grillo M, Amigoni P, Iascone M, Mortara A, Maron BJ, Senni M, Bruzzi P. Transaortic Chordal Cutting: Mitral Valve Repair for Obstructive Hypertrophic Cardiomyopathy With Mild Septal Hypertrophy. J Am Coll Cardiol. 2015 Oct 13;66(15):1687-96. doi: 10.1016/j.jacc.2015.07.069. PMID: 26449139.
9. Bogachev-Prokophiev A, Afanasyev AV, Zheleznev S, Pivkin A, Sharifulin R, Kozmin D, Karaskov A. Septal Myectomy With Vs Without Subvalvular Apparatus Intervention in Patients With Hypertrophic Obstructive Cardiomyopathy: A Prospective Randomized Study. Semin Thorac Cardiovasc Surg. 2019 Autumn;31(3):424-431. doi: 10.1053/j.semtcvs.2019.01.011. Epub 2019 Jan 11. PMID: 30641129.
10. Lapenna E, Alfieri O, Nisi T, De Bonis M. Mitral regurgitation in hypertrophic obstructive cardiomyopathy: The role of the edge-to-edge technique. J Card Surg. 2022 Oct;37(10):3336-3341. doi: 10.1111/jocs.15826. Epub 2021 Jul 19. PMID: 36054469.
11. Cooley DA. Surgical techniques for hypertrophic left ventricular obstructive myopathy including mitral valve plication. J Card Surg. 1991 Mar;6(1):29-33. doi: 10.1111/j.1540-8191.1991.tb00560.x. PMID: 1799731.
12. McIntosh CL, Maron BJ, Cannon RO 3rd, Klues HG. Initial results of combined anterior mitral leaflet plication and ventricular septal myotomy-myectomy for relief of left ventricular outflow tract obstruction in patients with hypertrophic cardiomyopathy. Circulation. 1992 Nov;86(5 Suppl):II60-7. PMID: 1424035.
13. van der Lee C, Kofflard MJ, van Herwerden LA, Vletter WB, ten Cate FJ. Sustained improvement after combined anterior mitral leaflet extension and myectomy in hypertrophic obstructive cardiomyopathy. Circulation. 2003 Oct 28;108(17):2088- 92. doi: 10.1161/01.CIR.0000092912.57140.
14. Epub 2003 Sep 29. PMID: 14517170. 14. Morrow AG. Hypertrophic subaortic stenosis. Operative methods utilized to relieve left ventricular outflow obstruction. J Thorac Cardiovasc Surg. 1978 Oct;76(4):423-30. PMID: 581298.
15. Afanasyev AV, Bogachev-Prokophiev AV, Zheleznev SI, Zalesov AS, Budagaev SA, Shajahmetova SV, Nazarov VM, Demin II, Sharifulin RM, Pivkin AN, Astapov DA, Cherniavsky AM. Early post-septal myectomy outcomes for hypertrophic obstructive cardiomyopathy. Asian Cardiovasc Thorac Ann. 2022 Jan;30(1):74-83. doi: 10.1177/02184923211056133. Epub 2021 Nov 10. PMID: 34757854.
16. Rowin EJ, Maron BJ, Chokshi A, Kannappan M, Arkun K, Wang W, Rastegar H, Maron MS. Clinical Spectrum and Management Implications of Left Ventricular Outflow Obstruction With Mild Ventricular Septal Thickness in Hypertrophic Cardiomyopathy. Am J Cardiol. 2018 Oct 15;122(8):1409-1420. doi: 10.1016/j.amjcard.2018.06.055. Epub 2018 Jul 17. PMID: 30107902.
17. Faisaluddin M, Ahmed A, Patel H, Thakkar S, Patel B, Balasubramanian S, Feitell SC, Shekar P, Rowin E, Maron M, Ganatra S, Dani SS. Surgical Outcomes of Septal Myectomy With and Without Mitral Valve Surgeries in Hypertrophic Cardiomyopathy: a National Propensity-Matched Analysis (2005 to 2020). Am J Cardiol. 2023 Oct 15;205:276-282. doi: 10.1016/j.amjcard.2023.07.150. Epub 2023 Aug 22. PMID: 37619494.
Review
For citations:
Kobzev E.E., Sosnina N.P., Rosseikin E.V. Morrow myoseptectomy without correction of moderate and severe mitral insufficiency. Minimally Invasive Cardiovascular Surgery. 2024;3(2):18-27. (In Russ.)