IMR Press / RCM / Volume 23 / Issue 8 / DOI: 10.31083/j.rcm2308279
Open Access Original Research
Myectomy with and without Mitral Subvalvular Repair in Patients with Hypertrophic Obstructive Cardiomyopathy with Grade 3 to 4+ Mitral Regurgitation without Intrinsic Mitral Valve Disease: A Retrospective Observational Study
Show Less
1 Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, 200032 Shanghai, China
2 Department of Cardiovascular Surgery, Xiamen Branch of Zhongshan Hospital, Fudan University, 361015 Xiamen, Fujian, China
3 Shanghai Municipal Institute for Cardiovascular Diseases, 200032 Shanghai, China
*Correspondence: (Chunsheng Wang); (Qiang Ji)
These authors contributed equally.
Academic Editor: Jinnette D. Abbott
Rev. Cardiovasc. Med. 2022, 23(8), 279;
Submitted: 11 April 2022 | Revised: 3 June 2022 | Accepted: 15 June 2022 | Published: 10 August 2022
(This article belongs to the Special Issue Structural Heart Interventions)
Copyright: © 2022 The Author(s). Published by IMR Press.
This is an open access article under the CC BY 4.0 license.

Background: Hypertrophic obstructive cardiomyopathy (HOCM) with severe mitral regurgitation (MR) remains controversial for the choice of the concomitant mitral valve (MV) management versus septal myectomy alone. The impacts of different surgical strategies (concomitant mitral subvalvular procedures versus myectomy alone) on one-year results of surgical treatment of HOCM with grade 3 to 4+ MR without intrinsic MV disease were evaluated in this single-center, retrospective observational study. Methods: A total of 146 eligible patients were retrospectively screened into a combined group (n = 40) and an alone group (n = 106), depending on whether they underwent transaortic mitral subvalvular procedures. Perioperative outcomes were collected, and results at 1-year following surgery were compared. Results: Surgical mortality did not differ (0 for combined group vs. 0.9% for alone group, p = 0.538). Six patients (5.0% vs. 3.8%, p = 0.666) developed postoperative complete atrioventricular node block with permanent pacemaker implantation. No death or reoperation was recorded during a median follow-up of 18 months. At 1-year following surgery, (1) the provoked MR severity decreased from baseline in both groups with a significant difference between groups [1.0 (0–1.0) vs. 1.0 (1.0–1.3), p < 0.001]; (2) systolic anterior motion (SAM) was observed in 10 patients (0 vs. 10 in the alone group, p = 0.043); (3) the provoked gradient was also significantly lower than baseline value for each group, with a significant difference between the two groups (8.8 ± 4.3 mmHg vs. 12.1 ± 6.7 mmHg, p = 0.006); and (4) New York Heart Association class decreased from baseline value for each group (p < 0.001). Conclusions: In HOCM patients with grade 3 to 4+ MR without intrinsic MV disease, mitral subvalvular management during septal myectomy may be associated with a low incidence of SAM, improved MR, and a lower outflow tract gradient in comparison with septal myectomy alone.

hypertrophic obstructive cardiomyopathy
mitral regurgitation
septal myectomy
mitral subvalvular management
81770341/National Natural Science Foundation of China
Fig. 1.
Back to top