Surgical treatment for hypertrophic obstructive cardiomyopathy with moderate-to-severe mitral regurgitation through right mini-thoracotomy_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

JIANG Zhaolei ¹ ,  MEI Ju ¹ , TANG Min ¹ , LIU Hao ¹ , MA Nan ¹ , SHEN Sai’e ² , DING Fangbao ¹ , HUANG Jianbing ¹

1. Department of Cardiothoracic Surgery, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P.R.China;
2. Department of Anesthesiology, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, 200092, P.R.China;

Corresponding author：

MEI Ju, Email: ju_mei63@126.com

Keywords：

Hypertrophic obstructive cardiomyopathy; mitral regurgitation; systolic anterior motion; edge-to-edge

DOI：

10.7507/1007-4848.201911048

Video：

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Objective To explore the effect and safety of surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM) with mitral regurgitation (MR) through right mini-thoracotomy.Methods From January 2008 to June 2018, 54 patients with HOCM and moderate-to-severe MR underwent modified Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy, including 31 males and 23 females, with an average age of 47.1±12.6 years. All patients had systolic anterior motion (SAM) phenomenon. Preoperative left ventricular outflow tract pressure gradient (LVOTPG) was 93.6±32.8 mm Hg, interventricular septum thickness (IVST) was 24.8±2.8 mm.Results Surgeries in all patients were completed successfully. No early death or interventricular septal perforation occurred. One (1.9%) patient received permanent pacemaker implantation due to the complete atrial-ventricular block. At discharge, postoperative LVOTPG (18.1±6.2 mm Hg) and IVST (14.5±2.1 mm) were significantly decreased compared with the preoperative values (P<0.05). No MR or SAM was observed in all patients. The follow-up time was 6-132 months, and during this period, no death, MR or SAM occurred. The average LVOTPG was 19.4±5.7 mm Hg, and the average IVST was 14.2±1.5 mm.Conclusion Morrow procedure and edge-to-edge mitral valvuloplasty through right mini-thoracotomy is a safe and effective method for treatment of HOCM with moderate-to-severe MR.

Citation： JIANG Zhaolei, MEI Ju, TANG Min, LIU Hao, MA Nan, SHEN Sai’e, DING Fangbao, HUANG Jianbing. Surgical treatment for hypertrophic obstructive cardiomyopathy with moderate-to-severe mitral regurgitation through right mini-thoracotomy. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(7): 754-757. doi: 10.7507/1007-4848.201911048 Copy

1.	Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet, 2017, 389(10075): 1253-1267.
2.	Kotkar KD, Said SM, Dearani JA, et al. Hypertrophic obstructive cardiomyopathy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2017, 6(4): 329-336.
3.	Pelliccia F, Pasceri V, Limongelli G, et al. Long-term outcome of nonobstructive versus obstructive hypertrophic cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol, 2017, 243: 379-384.
4.	Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy: Echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. Ann Thorac Surg, 2003, 75(2): 620-632.
5.	Brown ML, Schaff HV. Surgical management of obstructive hypertrophic cardiomyopathy: The gold standard. Expert Rev Cardiovasc Ther, 2008, 6(5): 715-722.
6.	Geske JB, Ommen SR, Gersh BJ. Hypertrophic cardiomyopathy: Clinical update. JACC Heart Fail, 2018, 6(5): 364-375.
7.	Afanasyev A, Bogachev-Prokophiev A, Lenko E, et al. Myectomy with mitral valve repair versus replacement in adult patients with hypertrophic obstructive cardiomyopathy: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2019, 28(3): 465-472.
8.	Price J, Clarke N, Turer A, et al. Hypertrophic obstructive cardiomyopathy: Review of surgical treatment. Asian Cardiovasc Thorac Ann, 2017, 25(9): 594-607.
9.	Lawrance CP, Henn MC, Miller JR, et al. A minimally invasive Cox maze Ⅳ procedure is as effective as sternotomy while decreasing major morbidity and hospital stay. J Thorac Cardiovasc Surg, 2014, 148(3): 955-961.
10.	姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口主动脉瓣置换术的对比研究. 中国胸心血管外科临床杂志, 2014, 21(6): 762-765.
11.	姜兆磊, 梅举, 汤敏, 等. 改良人工腱索技术在右胸微创切口二尖瓣成形术中的应用及效果评价. 中国心血管病研究, 2017, 15(5): 406-409, 后插1.
12.	Roberts CS, McIntosh CL, Brown PS Jr, et al. Reoperation for persistent outflow obstruction in hypertrophic cardiomyopathy. Ann Thorac Surg, 1991, 51(3): 455-460.
13.	Schwammenthal E, Nakatani S, He S, et al. Mechanism of mitral regurgitation in hypertrophic cardiomyopathy: Mismatch of posterior to anterior leaflet length and mobility. Circulation, 1998, 98(9): 856-865.
14.	Kwon DH, Setser RM, Thamilarasan M, et al. Abnormal papillary muscle morphology is independently associated with increased left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Heart, 2008, 94(10): 1295-1301.
15.	Teo EP, Teoh JG, Hung J, et al. Mitral valve and papillary muscle abnormalities in hypertrophic obstructive cardiomyopathy. Curr Opin Cardiol, 2015, 30(5): 475-482.
16.	Sherrid MV, Balaram S, Kim B, et al. The mitral valve in obstructive hypertrophic cardiomyopathy: A test in context. J Am Coll Cardiol, 2016, 67(15): 1846-1858.
17.	Raffa GM, Romano G, Turrisi M, et al. Pathoanatomic findings and treatment during hypertrophic obstructive cardiomyopathy surgery: The role of mitral valve. Heart Lung Circ, 2019, 28(3): 477-485.
18.	De Bonis M, Lapenna E, Taramasso M, et al. Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: up to 21 years of clinical and echocardiographic results. J Thorac Cardiovasc Surg, 2014, 148(5): 2027-2032.
19.	Alfieri O, Maisano F. An effective technique to correct anterior mitral leaflet prolapse. J Card Surg, 1999, 14(6): 468-470.
20.	Obadia JF, Basillais N, Armoiry X, et al. Hypertrophic cardiomyopathy: The edge-to-edge secures the correction of the systolic anterior motion. Eur J Cardiothorac Surg, 2017, 51(4): 638-643.

1. Veselka J, Anavekar NS, Charron P. Hypertrophic obstructive cardiomyopathy. Lancet, 2017, 389(10075): 1253-1267.
2. Kotkar KD, Said SM, Dearani JA, et al. Hypertrophic obstructive cardiomyopathy: The Mayo Clinic experience. Ann Cardiothorac Surg, 2017, 6(4): 329-336.
3. Pelliccia F, Pasceri V, Limongelli G, et al. Long-term outcome of nonobstructive versus obstructive hypertrophic cardiomyopathy: A systematic review and meta-analysis. Int J Cardiol, 2017, 243: 379-384.
4. Sherrid MV, Chaudhry FA, Swistel DG. Obstructive hypertrophic cardiomyopathy: Echocardiography, pathophysiology, and the continuing evolution of surgery for obstruction. Ann Thorac Surg, 2003, 75(2): 620-632.
5. Brown ML, Schaff HV. Surgical management of obstructive hypertrophic cardiomyopathy: The gold standard. Expert Rev Cardiovasc Ther, 2008, 6(5): 715-722.
6. Geske JB, Ommen SR, Gersh BJ. Hypertrophic cardiomyopathy: Clinical update. JACC Heart Fail, 2018, 6(5): 364-375.
7. Afanasyev A, Bogachev-Prokophiev A, Lenko E, et al. Myectomy with mitral valve repair versus replacement in adult patients with hypertrophic obstructive cardiomyopathy: A systematic review and meta-analysis. Interact Cardiovasc Thorac Surg, 2019, 28(3): 465-472.
8. Price J, Clarke N, Turer A, et al. Hypertrophic obstructive cardiomyopathy: Review of surgical treatment. Asian Cardiovasc Thorac Ann, 2017, 25(9): 594-607.
9. Lawrance CP, Henn MC, Miller JR, et al. A minimally invasive Cox maze Ⅳ procedure is as effective as sternotomy while decreasing major morbidity and hospital stay. J Thorac Cardiovasc Surg, 2014, 148(3): 955-961.
10. 姜兆磊, 梅举, 丁芳宝, 等. 微创右胸切口与常规胸骨正中切口主动脉瓣置换术的对比研究. 中国胸心血管外科临床杂志, 2014, 21(6): 762-765.
11. 姜兆磊, 梅举, 汤敏, 等. 改良人工腱索技术在右胸微创切口二尖瓣成形术中的应用及效果评价. 中国心血管病研究, 2017, 15(5): 406-409, 后插1.
12. Roberts CS, McIntosh CL, Brown PS Jr, et al. Reoperation for persistent outflow obstruction in hypertrophic cardiomyopathy. Ann Thorac Surg, 1991, 51(3): 455-460.
13. Schwammenthal E, Nakatani S, He S, et al. Mechanism of mitral regurgitation in hypertrophic cardiomyopathy: Mismatch of posterior to anterior leaflet length and mobility. Circulation, 1998, 98(9): 856-865.
14. Kwon DH, Setser RM, Thamilarasan M, et al. Abnormal papillary muscle morphology is independently associated with increased left ventricular outflow tract obstruction in hypertrophic cardiomyopathy. Heart, 2008, 94(10): 1295-1301.
15. Teo EP, Teoh JG, Hung J, et al. Mitral valve and papillary muscle abnormalities in hypertrophic obstructive cardiomyopathy. Curr Opin Cardiol, 2015, 30(5): 475-482.
16. Sherrid MV, Balaram S, Kim B, et al. The mitral valve in obstructive hypertrophic cardiomyopathy: A test in context. J Am Coll Cardiol, 2016, 67(15): 1846-1858.
17. Raffa GM, Romano G, Turrisi M, et al. Pathoanatomic findings and treatment during hypertrophic obstructive cardiomyopathy surgery: The role of mitral valve. Heart Lung Circ, 2019, 28(3): 477-485.
18. De Bonis M, Lapenna E, Taramasso M, et al. Very long-term durability of the edge-to-edge repair for isolated anterior mitral leaflet prolapse: up to 21 years of clinical and echocardiographic results. J Thorac Cardiovasc Surg, 2014, 148(5): 2027-2032.
19. Alfieri O, Maisano F. An effective technique to correct anterior mitral leaflet prolapse. J Card Surg, 1999, 14(6): 468-470.
20. Obadia JF, Basillais N, Armoiry X, et al. Hypertrophic cardiomyopathy: The edge-to-edge secures the correction of the systolic anterior motion. Eur J Cardiothorac Surg, 2017, 51(4): 638-643.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Surgical treatment for hypertrophic obstructive cardiomyopathy with moderate-to-severe mitral regurgitation through right mini-thoracotomy

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