Comparison of myectomy alone or in combination with mitral valve repair for hypertrophic obstructive cardiomyopathy
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D Fritzsche1, R Krakor, H Goos
1Clinic of Cardiac and Vascular Surgery, University of Leipzig, Germany.
Insights
Patients with hypertrophic obstructive cardiomyopathy (HOCM) undergoing myectomy with mitral valve repair (group 2) showed greater clinical and functional improvements compared to myectomy alone (group 1). This suggests combined procedures offer superior outcomes for HOCM patients.
Area of Science:
- Cardiovascular Surgery
- Cardiology
- Cardiac Physiology
Background:
- Hypertrophic obstructive cardiomyopathy (HOCM) is a complex cardiac condition requiring surgical intervention.
- The Morrow technique is a surgical approach for HOCM, sometimes requiring concomitant mitral valve procedures.
Purpose of the Study:
- To compare the clinical and functional outcomes of HOCM patients treated with the Morrow technique alone versus those also undergoing mitral valve surgery.
- To assess changes in left-ventricular function, heart muscle mass, and receptor density postoperatively.
Main Methods:
- Retrospective analysis of 56 HOCM patients between 1/84 and 6/91.
- Group 1: Morrow technique (n=40). Group 2: Morrow technique with mitral valve replacement/reconstruction (n=16).
- Postoperative assessment included echocardiography, ECG, symptomatology, and beta-adrenoreceptor/calcium channel density measurements.
Main Results:
- Significant reduction in pressure gradients observed in both groups postoperatively.
- Group 2 demonstrated a significant decrease in the time-to-peak-velocity/left-ventricular-ejection-time quotient.
- Echocardiography revealed a significant decrease in heart muscle mass in both groups; Ca(++)-channel density was elevated universally.
Conclusions:
- Patients undergoing myectomy combined with mitral valve surgery (group 2) experienced the most substantial improvements in clinical and left-ventricular functional parameters.
- Combined surgical approach may offer superior benefits for select HOCM patients.
Unlabelled:
Between 1/84 and 6/91 56 patients were treated for hypertrophic obstructive cardiomyopathy (HOCM): the Morrow technique alone was performed on 40 patients (group 1), in 16 patients (group 2) an additional replacement (n = 13) or reconstruction (n = 3) of the mitral valve was indicated. In a total of 14 cases coronary artery bypass grafting and aortic valve replacement was performed in addition. Postoperatively (mean follow-up 4.2 yrs, 141 patient-years) left-ventricular diastolic and systolic function parameters, heart muscle mass, ECG findings, and symptomatology were recorded and the ratios of beta-adrenoreceptor density to density of the calcium channel were measured.
Results:
Pressure gradient decreased from 69.2 +/- 5.2 (group 1) and 75.1 +/- 4.8 (group 2) to 23.3 +/- 2.7 and 11.7 +/- 2.2 mmHg postoperatively. Likewise Sokolow-Lyon index decreased from 3.5 +/- 0.2/3.7 +/- 0.2 to 2.9 +/- 0.2/2.8 +/- 0.3. The quotient time-to-peak-velocity/left-ventricular-ejection-time decreased significantly in group 2 from 58.6 +/- 6.3 to 41.9 +/- 5.8 (p less than 0.05). The heart muscle mass, determined echocardiographically, decreased from 680g to 430g (p less than 0.05). Isovolumetric tension time, isovolumetric relaxation time, and E/A ratio at rest and after stress showed typical characteristics. Ca(++)-channel density was clearly raised in all patients, with no differences between the two groups being observable. We conclude from our results: The most marked improvements in clinical and left-ventricular functional parameters were experienced by patients in group 2 (myectomy+MVR).(ABSTRACT TRUNCATED AT 250 WORDS)