What Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation?

Calvin K N Wan, Joseph A. Dearani, Thoralf M. Sundt, Steve R. Ommen, Hartzell V Schaff

Research output: Contribution to journalArticle

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Abstract

Background: Many prefer mitral valve replacement (MVR) for patients with obstructive hypertrophic cardiomyopathy (HCM) and concomitant degenerative mitral regurgitation (MR). We reviewed our results of septal myectomy combined with mitral valve repair (MVrep) and MVR when these problems coexist. Methods: Between 1990 and 2006, 32 patients (56% men; mean age, 60.7 ± 16.7 years) underwent extended septal myectomy for HCM with concomitant MVrep or MVR for degenerative MR (4% of myectomies and 3% of isolated MVrep during the same period). Preoperatively, 63% were in New York Heart Association (NHYA) functional class III/IV. Preoperative peak left ventricular outflow tract (LVOT) gradient was 63.7 ± 37.6 mm Hg. Systolic anterior motion (SAM) was present in 94%, with severe MR in 88%. Results: Extended septal myectomy included concomitant MVrep in 28 (88%) or mechanical MVR in 4 (12%). MVrep included leaflet resection in 10 (36%), edge-to-edge stitch in 6 (21%), and leaflet plication in 8 (29%). An annuloplasty ring/band was used in 19 (68%) and commissural annuloplasty in 2 (7%). There was one early death (3%). At discharge, resting LVOT gradient was reduced to 10.2 ± 19.0 mm Hg (p < 0.005). Dismissal echocardiography in MVrep patients demonstrated chordal SAM in 6 (21%, p < 0.005). MR was absent or mild in 21 (75%) and moderate in 6 (21%; p < 0.005 vs preoperatively). At late follow-up, LVOT gradient was 2.5 ± 5.8 mm Hg, SAM resolved in all patients, and 2 had moderate MR; 24 (83%) were in NYHA class I/II (p < 0.005). Conclusions: Concomitant MVrep with myectomy for HCM and degenerative MR can be performed with low early mortality with satisfactory relief of LVOT obstruction and MR. Most patients have significant relief of symptoms. MVR can be avoided in most patients with degenerative MR and HCM.

Original languageEnglish (US)
Pages (from-to)727-732
Number of pages6
JournalAnnals of Thoracic Surgery
Volume88
Issue number3
DOIs
StatePublished - Sep 2009

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Hypertrophic Cardiomyopathy
Mitral Valve Insufficiency
Mitral Valve
Therapeutics
Ventricular Outflow Obstruction
Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

What Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation? / Wan, Calvin K N; Dearani, Joseph A.; Sundt, Thoralf M.; Ommen, Steve R.; Schaff, Hartzell V.

In: Annals of Thoracic Surgery, Vol. 88, No. 3, 09.2009, p. 727-732.

Research output: Contribution to journalArticle

Wan, Calvin K N ; Dearani, Joseph A. ; Sundt, Thoralf M. ; Ommen, Steve R. ; Schaff, Hartzell V. / What Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation?. In: Annals of Thoracic Surgery. 2009 ; Vol. 88, No. 3. pp. 727-732.
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abstract = "Background: Many prefer mitral valve replacement (MVR) for patients with obstructive hypertrophic cardiomyopathy (HCM) and concomitant degenerative mitral regurgitation (MR). We reviewed our results of septal myectomy combined with mitral valve repair (MVrep) and MVR when these problems coexist. Methods: Between 1990 and 2006, 32 patients (56{\%} men; mean age, 60.7 ± 16.7 years) underwent extended septal myectomy for HCM with concomitant MVrep or MVR for degenerative MR (4{\%} of myectomies and 3{\%} of isolated MVrep during the same period). Preoperatively, 63{\%} were in New York Heart Association (NHYA) functional class III/IV. Preoperative peak left ventricular outflow tract (LVOT) gradient was 63.7 ± 37.6 mm Hg. Systolic anterior motion (SAM) was present in 94{\%}, with severe MR in 88{\%}. Results: Extended septal myectomy included concomitant MVrep in 28 (88{\%}) or mechanical MVR in 4 (12{\%}). MVrep included leaflet resection in 10 (36{\%}), edge-to-edge stitch in 6 (21{\%}), and leaflet plication in 8 (29{\%}). An annuloplasty ring/band was used in 19 (68{\%}) and commissural annuloplasty in 2 (7{\%}). There was one early death (3{\%}). At discharge, resting LVOT gradient was reduced to 10.2 ± 19.0 mm Hg (p < 0.005). Dismissal echocardiography in MVrep patients demonstrated chordal SAM in 6 (21{\%}, p < 0.005). MR was absent or mild in 21 (75{\%}) and moderate in 6 (21{\%}; p < 0.005 vs preoperatively). At late follow-up, LVOT gradient was 2.5 ± 5.8 mm Hg, SAM resolved in all patients, and 2 had moderate MR; 24 (83{\%}) were in NYHA class I/II (p < 0.005). Conclusions: Concomitant MVrep with myectomy for HCM and degenerative MR can be performed with low early mortality with satisfactory relief of LVOT obstruction and MR. Most patients have significant relief of symptoms. MVR can be avoided in most patients with degenerative MR and HCM.",
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T1 - What Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation?

AU - Wan, Calvin K N

AU - Dearani, Joseph A.

AU - Sundt, Thoralf M.

AU - Ommen, Steve R.

AU - Schaff, Hartzell V

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N2 - Background: Many prefer mitral valve replacement (MVR) for patients with obstructive hypertrophic cardiomyopathy (HCM) and concomitant degenerative mitral regurgitation (MR). We reviewed our results of septal myectomy combined with mitral valve repair (MVrep) and MVR when these problems coexist. Methods: Between 1990 and 2006, 32 patients (56% men; mean age, 60.7 ± 16.7 years) underwent extended septal myectomy for HCM with concomitant MVrep or MVR for degenerative MR (4% of myectomies and 3% of isolated MVrep during the same period). Preoperatively, 63% were in New York Heart Association (NHYA) functional class III/IV. Preoperative peak left ventricular outflow tract (LVOT) gradient was 63.7 ± 37.6 mm Hg. Systolic anterior motion (SAM) was present in 94%, with severe MR in 88%. Results: Extended septal myectomy included concomitant MVrep in 28 (88%) or mechanical MVR in 4 (12%). MVrep included leaflet resection in 10 (36%), edge-to-edge stitch in 6 (21%), and leaflet plication in 8 (29%). An annuloplasty ring/band was used in 19 (68%) and commissural annuloplasty in 2 (7%). There was one early death (3%). At discharge, resting LVOT gradient was reduced to 10.2 ± 19.0 mm Hg (p < 0.005). Dismissal echocardiography in MVrep patients demonstrated chordal SAM in 6 (21%, p < 0.005). MR was absent or mild in 21 (75%) and moderate in 6 (21%; p < 0.005 vs preoperatively). At late follow-up, LVOT gradient was 2.5 ± 5.8 mm Hg, SAM resolved in all patients, and 2 had moderate MR; 24 (83%) were in NYHA class I/II (p < 0.005). Conclusions: Concomitant MVrep with myectomy for HCM and degenerative MR can be performed with low early mortality with satisfactory relief of LVOT obstruction and MR. Most patients have significant relief of symptoms. MVR can be avoided in most patients with degenerative MR and HCM.

AB - Background: Many prefer mitral valve replacement (MVR) for patients with obstructive hypertrophic cardiomyopathy (HCM) and concomitant degenerative mitral regurgitation (MR). We reviewed our results of septal myectomy combined with mitral valve repair (MVrep) and MVR when these problems coexist. Methods: Between 1990 and 2006, 32 patients (56% men; mean age, 60.7 ± 16.7 years) underwent extended septal myectomy for HCM with concomitant MVrep or MVR for degenerative MR (4% of myectomies and 3% of isolated MVrep during the same period). Preoperatively, 63% were in New York Heart Association (NHYA) functional class III/IV. Preoperative peak left ventricular outflow tract (LVOT) gradient was 63.7 ± 37.6 mm Hg. Systolic anterior motion (SAM) was present in 94%, with severe MR in 88%. Results: Extended septal myectomy included concomitant MVrep in 28 (88%) or mechanical MVR in 4 (12%). MVrep included leaflet resection in 10 (36%), edge-to-edge stitch in 6 (21%), and leaflet plication in 8 (29%). An annuloplasty ring/band was used in 19 (68%) and commissural annuloplasty in 2 (7%). There was one early death (3%). At discharge, resting LVOT gradient was reduced to 10.2 ± 19.0 mm Hg (p < 0.005). Dismissal echocardiography in MVrep patients demonstrated chordal SAM in 6 (21%, p < 0.005). MR was absent or mild in 21 (75%) and moderate in 6 (21%; p < 0.005 vs preoperatively). At late follow-up, LVOT gradient was 2.5 ± 5.8 mm Hg, SAM resolved in all patients, and 2 had moderate MR; 24 (83%) were in NYHA class I/II (p < 0.005). Conclusions: Concomitant MVrep with myectomy for HCM and degenerative MR can be performed with low early mortality with satisfactory relief of LVOT obstruction and MR. Most patients have significant relief of symptoms. MVR can be avoided in most patients with degenerative MR and HCM.

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