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Mitral Leaflet Shortening as an Ancillary Procedure in Obstructive Hypertrophic Cardiomyopathy

Daniel G Swistel1, Daniele Massera2, Alexandra Stepanovic2

  • 1Department of Cardiothoracic Surgery, NYU School of Medicine, New York, New York.

The Annals of Thoracic Surgery
|March 22, 2024
PubMed

Insights

Mitral leaflet shortening combined with myectomy in hypertrophic cardiomyopathy (HCM) patients showed similar survival and echocardiographic outcomes compared to myectomy alone. This suggests leaflet shortening is a safe and effective adjunct for selected HCM patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Research

Background:

  • Mitral leaflet elongation is common in hypertrophic cardiomyopathy (HCM), complicating surgical goals.
  • Anterior mitral leaflet shortening during myectomy is a controversial ancillary procedure.

Purpose of the Study:

  • To compare the outcomes of myectomy with concomitant mitral leaflet shortening versus myectomy alone in HCM patients.
  • To evaluate the safety and efficacy of evolving mitral shortening techniques (plication vs. ReLex).

Main Methods:

  • Retrospective study of 416 patients undergoing myectomy (2010-2020).
  • Comparison of outcomes between patients receiving myectomy with mitral shortening and those receiving myectomy alone.
  • Analysis of survival and echocardiographic data, including evolving mitral shortening techniques.

Main Results:

  • Hospital mortality was 0.7%.
  • At 8 years, cumulative survival was 95% for both groups (myectomy with leaflet shortening vs. myectomy alone), with no significant difference.
  • Echocardiography at 2.5 years showed similar reductions in gradients, mitral regurgitation, and left atrial volume between groups.

Conclusions:

  • Mitral shortening is an appropriate surgical consideration for selected HCM patients.
  • The study supports the use of mitral leaflet shortening as an adjunct to myectomy.
  • No significant difference in survival or echocardiographic outcomes was observed between leaflet shortening techniques.
Abstract

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