BACKGROUND: To assess the long-term clinical and echocardiographic outcomes of the Edge-to-Edge (EE) mitral repair added to septal myectomy in patients with mitral regurgitation (MR) and hypertrophic obstructive cardiomyopathy (HOCM). METHODS: This is a single-center study of 26 HOCM patients (septal thickness 17±3mm, resting LVOT gradient 63±20mmHg, MR≥2+/4+), submitted to EE mitral procedure combined with ventricular septal myectomy. The EE was used to treat MR due to systolic anterior motion (SAM) in 19 patients (73%) and to posterior leaflet prolapse/flail in 7(27%). RESULTS: Hospital mortality was 4%. Follow-up was 100% complete, median 6.5 years[IQR2.7;9]. Freedom from cardiac death was 88±8.4% at 8 years. The 8-year Cumulative incidence function (CIF) of reoperation with death as competing risk, was 7.7±5.2%. At 8-years, the CIF of recurrence of MR≥3+ with death as competing risk, was 7.9±5.3%. Residual MR at discharge (HR=8.3, 95%CI 2.1-32.6, p=0.002) and preoperative SPAP (HR=1.0, 95%CI 1.0-1.1, p=0.005) were identified as predictors of MR recurrence. At the last follow-up, 92% of patients were in NYHA class I-II and 72% in sinus rhythm. The last echocardiographic follow-up showed a median resting LVOT gradient of 9 mmHg[IQR7;12] (p<0.0001 vs preop). CONCLUSIONS: In HOCM patients, when septal thickness was considered inadequate to allow a safe and effective myectomy, the EE technique provided a simple, quick and effective solution by abolishing at the same time residual gradient and SAM-related MR. Organic MV lesions such as prolapse/flail could be addressed as well, whenever indicated. Satisfactory clinical and echocardiographic results were maintained at long-term follow-up.
BACKGROUND: To assess the long-term clinical and echocardiographic outcomes of the Edge-to-Edge (EE) mitral repair added to septal myectomy in patients with mitral regurgitation (MR) and hypertrophic obstructive cardiomyopathy (HOCM). METHODS: This is a single-center study of 26 HOCM patients (septal thickness 17±3mm, resting LVOT gradient 63±20mmHg, MR≥2+/4+), submitted to EE mitral procedure combined with ventricular septal myectomy. The EE was used to treat MR due to systolic anterior motion (SAM) in 19 patients (73%) and to posterior leaflet prolapse/flail in 7(27%). RESULTS: Hospital mortality was 4%. Follow-up was 100% complete, median 6.5 years[IQR2.7;9]. Freedom from cardiac death was 88±8.4% at 8 years. The 8-year Cumulative incidence function (CIF) of reoperation with death as competing risk, was 7.7±5.2%. At 8-years, the CIF of recurrence of MR≥3+ with death as competing risk, was 7.9±5.3%. Residual MR at discharge (HR=8.3, 95%CI 2.1-32.6, p=0.002) and preoperative SPAP (HR=1.0, 95%CI 1.0-1.1, p=0.005) were identified as predictors of MR recurrence. At the last follow-up, 92% of patients were in NYHA class I-II and 72% in sinus rhythm. The last echocardiographic follow-up showed a median resting LVOT gradient of 9 mmHg[IQR7;12] (p<0.0001 vs preop). CONCLUSIONS: In HOCM patients, when septal thickness was considered inadequate to allow a safe and effective myectomy, the EE technique provided a simple, quick and effective solution by abolishing at the same time residual gradient and SAM-related MR. Organic MV lesions such as prolapse/flail could be addressed as well, whenever indicated. Satisfactory clinical and echocardiographic results were maintained at long-term follow-up.
Authors: Giuseppe M Raffa; Eluisa La Franca; Carlo Lachina; Andrea Palmeri; Mariusz Kowalewski; Steven Lebowitz; Alessandro Ricasoli; Matteo Greco; Sergio Sciacca; Marco Turrisi; Marco Morsolini; Vincenzo Stringi; Gabriella Mattiucci; Michele Pilato Journal: Front Cardiovasc Med Date: 2022-06-15