Аpplication extanded myoectomy in surgical treatment obstructive hypertrophic cardiomyopathy: immediate results
Published 2015-10-08
Keywords
- hypertrophic cardiomyopathy,
- myomectomy,
- heart failure
How to Cite
Copyright (c) 2015 Bogachev-Prokofiev A.V., Zheleznev S.I., Fomenko M.S., Afanasyev A.V., Sharifulin R.M., Pivkin A.N., Demidov D.P., Karaskov A.M.
This work is licensed under a Creative Commons Attribution 4.0 International License.
Abstract
Background. Sudden cardiac death (SCD) has been recognized as one of the most devastating outcomes of hypertrophic cardiomyopathy (HCM). According to 2011 ACCF/AHA guidelines extended myomectomy, or myomectomy by Morrow, is the gold standard in treatment of patients with HOCM, however, the design of excision volume and mitral subvalvular apparatus (MSA) intervention is still unclear.
Objective. The purpose of this study was to evaluate the design of excision volume during extended septal myectomy in patients with HOCM, as well as the safety and efficacy of this procedure.
Methods. Between 2011 and 2013, 53 patients underwent extended myectomy procedures at our center. Mean age was 52.8±14.2 years (ranging from 22 to 74 years), with mean peak gradient reaching 89.9±27.2 mm Hg and thickness of the interventricular septum amounting to 25.8±4.1 mm. SAM syndrome was detected in all patients, with severe and moderate MR observed in 39 (73.5%) patients. The design of excision volume was based on MRI and TEE. To evaluate the results, use was made of TEE and direct tensiometry.
Results. All procedures were performed with cardiopulmonary bypass (CPB) under mild (32° to 34°C) hypothermia. Mean CPB time was 119±40 minutes, cross clamping time was 88±34 minutes. In 52 (98.2%) cases radical extended myomectomy was performed on the basis of our excision volume design. In one (1.8%) case we had to additionally excise the mid area of the interventricular septum in order to obtain TEE and hemodynamic data. Postoperative SAM-syndrome was not observed in all cases. No early death was recorded. Peak LVOT gradient was 9.3±3.5 mm Hg (according to direct tensiometry) and 16.8±7.4 mmHg (according to TEE). Complete atrioventricular block was noted in 5 (9.4%) cases, in one (1.8%) case ventricular septal defect occurred.
Conclusion. Our design of the excision volume for septal myectomy in patients with HOMC may be safely and effectively used for radical extended myomectomy.
References
- Rick A. Nishimura, Steve R. Ommen. Septal Reduction Therapy for Obstructive Hypertrophic Cardiomyopathy and Sudden Death: What Statistics Cannot Tell You // Circ. Cardiovasc. Interv. 2010. Vol. 3. P. 91–93.
- Robert A. Leonardi, Evan P. Kransdorf, David L. Simel and Andrew Wang. Meta-Analyses of Septal Reduction Therapies for Obstructive Hypertrophic Cardiomyopathy Comparative Rates of Overall Mortality and Sudden Cardiac Death After Treatment // Circ. Cardiovasc. Interv. 2010. Vol. 3. P. 97–104.
- A report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy // J. Thorac. Cardiovasc. Surg. 2011. Vol. 142. P. 153–203.
- Morrow A.F. Hypertrophic subaortic stenosis. Operative methods utilized to relieve left ventricular outflow obstruction // J. Thorac. Cardiovasc. Surg. 1978. Vol. 76. P. 423–30.
- Balaram S.K., Sherrid M.V., Derose J.J. Jr., Hillel Z., Winson G, Swistel D.G. Beyond extended myectomy for hypertrophic cardiomyopathy: resection-plication-release (RPR) repair // Ann. Thorac. Surg. 2005. Vol. 80. P. 217–23.
- Cooley D.A. Surgical technique for hypertrophic left ventricular obstructive myopathy including mitral valve plication // J. Cardiac.Surg. 1991. Vol. 6. P. 29–33.
- Maslow A.D., Regan M.M., Haering J.M., Johnson R.G., Levine R.A. Echocardiographic predictors of left ventricular outflow tract obstruction and systolic anterior motion of the mitral valve after mitral valve reconstruction for myxomatous valve disease // J. Am. Coll. Cardiol. 1999. Vol. 34. P. 2096–104.
- Lee K.S., Stewart W.J., Lever H.M., Underwood P.L., Cosgrove D.M. Mechanism of outflow tract obstruction causing failed mitral valve repair. Anterior displacement of leaflet coaptation //Circulation. 1993. Vol. 88. P. II24–9.
- Kaple R.K., Murphy R.T., DiPaola L.M., et al. Mitral valve abnormalities in hypertrophic cardiomyopathy: echocardiographic features and surgical outcomes // Ann. Thorac. Surg. 2008. Vol. 85. P. 1527–35, 1535.e1–2.
- Balaram S.K., Tyrie L., Sherrid M.V., et al. Resection-plicationrelease for hypertrophic cardiomyopathy: clinical and echocardiographic follow-up // Ann. Thorac. Surg. 2008. Vol. 86. P. 1539–44.
- Schaff H.V., Suri R.M., Enriquez-Sarano M. Indications for surgery in degenerative mitral valve disease // Semin. Thorac. Cardiovasc. Surg. 2007. Vol. 19. P. 97–102.
- Enriquez-Sarano M., Avierinos J.F., Messika-Zeitoun D., et al. Quantitative determinants of the outcome of asymptomatic mitral regurgitation // N. Engl. J. Med. 2005. Vol. 352. P. 875–83.
- Calvin K.N. Wan, Joseph A. Dearani, Thoralf M. Sundt, et al. What Is the Best Surgical Treatment for Obstructive Hypertrophic Cardiomyopathy and Degenerative Mitral Regurgitation? // Ann. Thorac. Surg. 2009. Vol. 88. P. 727–32.
- Minakata K., Dearani J.A., Nishimura R.A., et al. Extended septal myectomy for hypertrophic obstructive cardiomyopathy with anomalous mitral papillary muscles or chordae // J. Thorac. Cardiovasc. Surg. 2004. Vol. 127. P. 481–9
- Железнев С.И., Богачев-Прокофьев А.В., Емешкин М.И., Караськов А.М. Отдаленные результаты хирургического лечения фибрилляции предсердий у больных с приобретенными пороками митрального клапана // Патология кровообращения и кардиохирургия. 2014. № 1. С. 5–10.
- Тулеутаев Р.М., Богачев-Прокофьев А.В., Железнев С.И., АфанасьевА.В., Караськов А.М. Обратное ремоделирование левых камер сердца после реконструкции митрального клапана при мезенхимальной дисплазии // Патология кровообращения и кардиохирургия. 2015. Т. 19, № 1. С. 66–71.
- Sandhya K. Balaram, Ronald E. Ross, Mark V. Sherrid, Gary S. Schwartz, Zak Hillel, Glenda Winson, and Daniel G. Swistel. Role of Mitral Valve Plication in the Surgical Management of Hypertrophic Cardiomyopathy // Ann. Thorac. Surg. 2012. Vol. 94. P. 1990–1998.