Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL 33140, USA.
Coronary Care Unit, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, FL 33140, USA.
Rev Cardiovasc Med. 2021 Dec 22;22(4):1471-1477. doi: 10.31083/j.rcm2204151.
Left ventricular outflow tract (LVOT) obstruction and systolic anterior motion (SAM) of the mitral valve (MV) occurs in 70% of hypertrophic cardiomyopathy (HCM) patients. In individuals undergoing septal myectomy, concomitant MV surgery is considered for SAM with residual LVOT obstruction or mitral regurgitation (MR); however, the optimal approach remains debated. A literature search was performed in Pubmed, EMBASE, Ovid, and the Cochrane library of published articles through June 2021 reporting on combined septal myectomy and edge-to-edge MV repair for obstructive HCM. Continuous variables were weighted and compared using a student's -test, and categorical variables using a chi-square test with Yates correction. Six studies with 158 total patients were included. The mean follow-up was 2.8 ± 2.7 years. Compared with pre-operative values, there were significant reductions in the LV ejection fraction (69 ± 10 vs 59 ± 8%), peak LVOT gradient (82 ± 34 vs 16 ± 13 mmHg), prevalence of moderate or greater MR (84 vs 5 %), and presence of SAM (96% vs 0) ( < 0.001 for all). There was no change in LV internal diastolic diameter (4.2 ± 1.3 vs 4.4 ± 1.5 cm, = 0.32). There were 2 (1%) operative mortalities. At follow-up, the survival rate was 97%, there were 3 (2%) re-operative MV replacements, 4 (3%) patients remained in New York Heart Association functional class III/IV, and 8 (6%) required permanent pacemaker implantation. In conclusion, combined septal myectomy and edge-to-edge MV repair is a safe and effective treatment strategy in carefully selected patients requiring surgical HCM management.
左心室流出道（LVOT）梗阻和二尖瓣收缩期前向运动（SAM）发生在 70%的肥厚型心肌病（HCM）患者中。在行间隔心肌切除术的患者中，如果存在残留的 LVOT 梗阻或二尖瓣反流（MR），则考虑同时进行二尖瓣手术；然而，最佳方法仍存在争议。通过 2021 年 6 月在 Pubmed、EMBASE、Ovid 和 Cochrane 图书馆的已发表文章中进行了文献检索，报告了合并间隔心肌切除术和二尖瓣缘对缘修复术治疗梗阻性 HCM。使用学生 t 检验对连续变量进行加权比较，使用校正的卡方检验对分类变量进行比较。纳入了 6 项研究共 158 例患者。平均随访时间为 2.8 ± 2.7 年。与术前相比，左心室射血分数（69 ± 10%比 59 ± 8%）、峰值 LVOT 梯度（82 ± 34 比 16 ± 13mmHg）、中度或更严重的 MR 发生率（84%比 5%）和 SAM 存在率（96%比 0%）显著降低（所有 < 0.001）。左心室舒张内径（4.2 ± 1.3 比 4.4 ± 1.5cm， = 0.32）无变化。有 2 例（1%）手术死亡。随访时，存活率为 97%，有 3 例（2%）再次行二尖瓣置换术，4 例（3%）患者仍处于纽约心脏协会功能 III/IV 级，8 例（6%）需要植入永久性起搏器。总之，在仔细选择需要手术治疗 HCM 的患者中，联合间隔心肌切除术和二尖瓣缘对缘修复术是一种安全有效的治疗策略。
