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Concomitant Mitral Valve Surgery in a Modified Morrow Procedure in Patients with Hypertrophic Obstructive

Chunshui Liang1, Mingwen Li1, Ruiyan Ma1

  • 1Department of Cardiovascular Surgery, Xinqiao Hospital, The Army Medical University.

International Heart Journal
|March 30, 2025
PubMed

Insights

The modified Morrow procedure for hypertrophic obstructive cardiomyopathy (HOCM) is safe and effective when combined with mitral valve (MV) surgery. This approach successfully reduced left ventricular outflow tract gradients and mitral regurgitation (MR) in patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Cardiovascular Medicine

Background:

  • Ventricular septal myectomy, specifically the modified Morrow procedure, is the primary surgical treatment for hypertrophic obstructive cardiomyopathy (HOCM).
  • The necessity and indications for concurrent mitral valve (MV) procedures to address mitral regurgitation (MR) or intrinsic MV abnormalities during HOCM surgery remain debated.
  • Evaluating the safety and efficacy of combined MV surgery with the modified Morrow procedure is crucial for optimizing HOCM treatment.

Purpose of the Study:

  • To retrospectively analyze the safety and efficiency of concomitant mitral valve (MV) surgery during the modified Morrow procedure for hypertrophic obstructive cardiomyopathy (HOCM).
  • To assess the impact of combined procedures on left ventricular outflow tract (LVOT) gradients and mitral regurgitation (MR).

Main Methods:

  • Retrospective review of 56 consecutive patients with HOCM who underwent modified Morrow procedures with concomitant MV surgery between January 2019 and December 2021.
  • Analysis of baseline characteristics, perioperative data, and postoperative outcomes, including operative mortality, complications, LVOT gradients, and MR severity.
  • Follow-up data was collected to assess long-term outcomes and the need for reoperation.

Main Results:

  • Zero operative mortality was observed in the 56 patients.
  • Significant reduction in peak left ventricular outflow tract (LVOT) gradient from 93.6 ± 34.4 mm Hg to 20.5 ± 13.0 mm Hg.
  • Complete resolution of mitral regurgitation (MR) and systolic anterior motion (SAM) of the MV post-surgery; no cardiac reoperations were required during a mean follow-up of 13.8 months.

Conclusions:

  • Concomitant mitral valve (MV) surgery during the modified Morrow procedure is a safe and effective strategy for managing hypertrophic obstructive cardiomyopathy (HOCM) in most cases.
  • The combined approach successfully alleviates left ventricular outflow tract obstruction and mitral regurgitation (MR).
  • This combined surgical technique demonstrates favorable short-term outcomes without the need for reoperation.

Keywords:
Heart surgical procedureObstructive asymmetric septal hypertrophy

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