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Septal Myectomy and Subvalvular Repair in Hypertrophic Cardiomyopathy, a Systematic Review and Pooled Analysis

Ming-Yang Song1, Xiang Wei1,2,3,4, Chen-He Li1

  • 1Division of Cardiothoracic and Vascular Surgery, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, 430030 Wuhan, Hubei, China.

Reviews in Cardiovascular Medicine
|July 30, 2024
PubMed

Insights

Combining ventricular septectomy with mitral valve repair effectively treats hypertrophic obstructive cardiomyopathy (HOCM) patients with systolic anterior motion (SAM) and mitral regurgitation (MR). This combined approach significantly improves left ventricular outflow tract gradients and reduces MR severity.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Research

Background:

  • Some patients with hypertrophic obstructive cardiomyopathy (HOCM) experience persistent systolic anterior motion (SAM) and mitral regurgitation (MR) after isolated ventricular septectomy.
  • Optimal surgical management, including mitral valve intervention, remains debated for these complex cases.

Purpose of the Study:

  • To evaluate the efficacy and safety of combining ventricular septectomy with mitral valve repair in HOCM patients with SAM and severe MR.
  • To analyze outcomes and identify improvements in hemodynamic and functional parameters post-intervention.

Main Methods:

  • A systematic literature search was conducted across major databases (PubMed, Cochrane, Embase, Web of Science) for studies published before December 2022.
  • Ten studies involving 692 patients undergoing ventricular septal resection combined with mitral valve repair were analyzed for demographic and outcome data.
  • Risk of bias was assessed using MINORS, with statistical comparisons performed using Student's t-test and chi-square/Fisher's exact tests.

Main Results:

  • The combined procedure demonstrated a low perioperative mortality rate (0.7%) with an average follow-up of 39.6 months.
  • Significant improvements were observed in left ventricular outflow tract gradient, septal thickness, mitral regurgitation severity, AML-annulus ratio, tenting area, and SAM.
  • Patient functional status improved significantly, with a reduction in New York Heart Association functional class III/IV patients from 541/692 to 14/682.

Conclusions:

  • Ventricular septectomy combined with mitral valve repair is a safe and effective treatment for HOCM patients with SAM and severe MR.
  • This combined surgical strategy offers significant hemodynamic and functional benefits, addressing persistent postoperative complications.
Abstract

Keywords:
hypertrophic cardiomyopathymitral valve insufficiencyseptal myectomysubvalvuar repair

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