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Importance of surgical expertise in septal myectomy for obstructive hypertrophic cardiomyopathy

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Abstract

Objective

In 2011, a multidisciplinary hypertrophic cardiomyopathy (HCM) program with a dedicated myectomy surgeon was implemented at our institution. We hypothesized that a dedicated approach allows better identification and management of mitral regurgitation (MR) during septal myectomy (SM) for obstructive HCM with significant mitral regurgitation.

Methods

Between 2006 and 2018, 181 patients had SM at our institution. This study consists of 53 patients with preoperative moderate or greater MR associated with systolic anterior motion who underwent isolated SM with or without mitral intervention. Patients were divided into those who underwent SM by a dedicated myectomy surgeon (group D, n = 31) or by a non-dedicated surgeon (group ND, n = 22). Primary outcome of interest was rate of mitral valve replacement (MVR) at SM. Secondary outcomes include in-hospital mortality, need for permanent pacemaker, mitral valve reoperation, and residual MR and left ventricular outflow tract gradient on postoperative echocardiography.

Results

12 patients (55%) had a concomitant MVR during septal myectomy in group ND compared to 2 patients (6%) in group D (p < 0.01). Among patients who did not undergo MVR, patients in group D less commonly had residual MR than patients in ND after SM (p < 0.01). Group D had 100% survival with NYHA class I in 94% patients at follow-up visit (p = 0.01). Reoperation for MVR was required in four patients in group ND vs. none in group D (p < 0.01).

Conclusions

A dedicated surgeon is able to spare the mitral valve in patients undergoing SM. This study emphasizes the importance of surgical expertise in this cohort.

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Abbreviations

SM:

Septal myectomy

HCM:

Hypertrophic cardiomyopathy

LVOT:

Left ventricular outflow tract

MV:

Mitral valve

MVR:

Mitral valve replacement

SAM:

Systolic anterior motion

TEE:

Transesophageal echocardiogram

TTE:

Transthoracic echocardiogram

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Authors and Affiliations

  1. Department of Surgery, Division of Cardiothoracic Surgery, Columbia University Medical Center, 177 Fort Washington Ave, New York, NY, USA

    Sarah N. Yu, Koki Nakanishi, Michael P. Salna, Antonio Polanco, Yuting Chiang & Hiroo Takayama

  2. Department of Medicine, Division of Cardiology, Columbia University Medical Center, New York, NY, USA

    Yuichi J. Shimada & Shepard D. Weiner

  3. Weill Cornell Medical Center, New York Presbyterian Hospital, New York, NY, USA

    Jonathan N. Ginns

Authors
  1. Sarah N. Yu
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  2. Koki Nakanishi
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  9. Hiroo Takayama
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Corresponding author

Correspondence to Hiroo Takayama.

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Conflict of interest

Yuichi Shimada has received research funding from the American Heart Association. The remaining authors have no financial disclosures.

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Yu, S.N., Nakanishi, K., Ginns, J.N. et al. Importance of surgical expertise in septal myectomy for obstructive hypertrophic cardiomyopathy. Gen Thorac Cardiovasc Surg 68, 1094–1100 (2020). https://doi.org/10.1007/s11748-020-01320-7

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  • DOI: https://doi.org/10.1007/s11748-020-01320-7

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