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Updated: Sep 20, 2025
08:31
A Simplified Stepwise Approach to Echo Guidance during Percutaneous Mitral Valve Repair
Published on: October 16, 2021
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Left Ventricular Outflow Tract Modification During Robotic Mitral Valve Repair.
Didier F Loulmet1, Ali Hage1, Katherine G Phillips1
1Division of Cardiac Surgery, Department of Cardiothoracic Surgery, NYU Langone Health, New York, New York.
The Annals of Thoracic Surgery
|May 22, 2025
Summary
Left ventricular outflow tract modification effectively prevents systolic anterior motion after robotic mitral valve repair. This technique minimizes morbidity and avoids revision surgery in high-risk patients.
Area of Science:
- Cardiovascular Surgery
- Cardiac Echocardiography
- Minimally Invasive Cardiac Surgery
Background:
- Earlier mitral valve (MV) regurgitation intervention may increase systolic anterior motion (SAM) risk.
- Left ventricular outflow tract (LVOT) modification is explored to mitigate this risk.
- Totally endoscopic robotic MV repairs (TERMVRs) are increasingly performed.
Purpose of the Study:
- To assess the efficacy of LVOT modification in preventing postoperative SAM.
- To evaluate the safety and outcomes of LVOT modification during TERMVRs.
- To identify patients at increased risk for SAM.
Main Methods:
- 800 TERMVRs were analyzed from January 2019 to May 2024.
- Prebypass echocardiography assessed SAM risk (low, moderate, high).
- LVOT modification included ventricular septal bulge (VSB) myectomy or septal myocardial trabeculation (SMT) resection.
Main Results:
- 190 patients (23.8%) had increased SAM risk.
- LVOT modification was performed in 73.2% of high-risk patients.
- No intraoperative MV repair revisions for SAM were needed; one transient SAM event occurred.
Conclusions:
- A significant proportion of MV repair patients face elevated postoperative SAM risk.
- LVOT modification during TERMVRs is safe and effective.
- This strategy prevents SAM-related MV repair revisions.
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