OBJECTIVE

To evaluate an effectiveness of transaortic septal myectomy alone and in combination with mitral valve repair in patients with hypertrophic obstructive cardiomyopathy (HOCM).

MATERIAL AND METHODS

The study included 62 patients with HOCM and left ventricular outflow tract (LVOT) peak pressure gradient 109.1±29.8 mm Hg. Mean age of patients was 54.3±12.4 years. All patients were divided into 2 groups. Group 1 — 44 patients (19 men, 25 women) who underwent septal myectomy combined with transaortic mitral valve repair in edge-to-edge fashion, group 2 — 18 patients (7 men, 11 women) who underwent Morrow septal myectomy alone. Severe (III-IV) mitral insufficiency was observed in the first group, moderate regurgitation — in the second group. Follow-up data were assessed in early postoperative period, after 6, 12, 24, 36 and 60 months.

RESULTS

In the 1st group, LVOT pressure gradient decreased from 112.8±30.9 to 19.3±13.1 mm Hg, in the second group — from 101.1±25.4 to 20.7±16.0 mm Hg (p<0.05). Interventricular septum thickness decreased from 22.5±2.9 to 16.4±1.1 mm and from 20.4±5.4 to 17.3±3.8 mm, respectively (p<0.05). Mitral regurgitation grade decreased from 2.7±0.4 to 1.4±0.1 in the 1st group and from 1.9±0.4 to 1.7±0.5 in the 2nd group (p<0.05). In the early postoperative period, two patients from the 1st group required implantation of a two-chamber pacemaker due to complete atrioventricular blockade, in the 2nd group — 1 patient needed for this procedure. Heart failure NYHA class decreased from III-IV to I-II. There was no in-hospital and long-term mortality.

CONCLUSION

Morrow septal myectomy alone is the gold standard in the treatment of HOCM with moderate mitral regurgitation. In HOCM with severe mitral regurgitation, combination of this surgery with transaortic mitral valve repair ensures more significant and long-lasting improvement of mitral regurgitation.