[Meta-analysis on the relevance of septal myectomy in aortic valve replacement]

To study hemodynamic parameters according to the data of echocardiography, as well as to evaluate the incidence of complications in the early and late post-operative periods in patients who underwent septal myectomy during aortic valve replacement.

A search for articles in the PubMed database was conducted considering the PRISMA guidelines. The clinical trial had to meet the following criteria: 1) the presence of two comparison groups: aortic valve replacement (AVR) and AVR+septal myectomy (SME); 2) hypertrophy of the left ventricular outflow tract (LVOT) should be associated with severe aortic stenosis. Keywords for searching on the PubMed digital platform (according to MeSH): «aortic stenosis», «aortic valve», «septal myectomy». Statistical analysis was performed using Review Manager (RevMan) software, 5.4.1 (The Cochrane Collaboration, 2020) version. The meta-analysis results are presented as a forest plot. The heterogeneity of the studied sample was assessed using χ² test and I² heterogeneity index in each case. The heterogeneity was considered to be statistically significant at p<0.1 and I²>50%.

There were no statistically significant differences between the groups in the risk of fatal outcome in both the early (p=0.85) and late (p=0.89) post-operative periods. The thickness of the LV posterior wall (95% confidence interval - CI from -0.93 to -0.03), LV end-diastolic dimension (95% CI from -3.67 to -0.29) were lower in the AVR+SME group than in patients of the comparison group.

This meta-analysis demonstrates that SME in AVR is safe procedure and promotes reverse myocardium remodeling in a greater extent than performing isolated AVR. However, the number of studies for analysis was small and the investigated publications are retrospective analysis with investigation of different endpoints. Furthermore, not every study reports important factors contributing to LV remodeling.