OBJECTIVE

To analyze the immediate and mid-term results of septal myectomy and aortic valve replacement in patients with severe aortic stenosis.

MATERIAL AND METHODS

A retro- and prospective analysis included 148 patients with severe aortic stenosis and interventricular septal hypertrophy ≥1.5 cm between 2012 and 2022. Age of patients was 63.0 (60; 66) years. The study included 89 (60%) men and 59 (40%) women. There were 88 patients (60%) with heart failure NYHA class III and 48 (32%) ones with class II. Patients were divided into two groups. Both groups did not differ in clinical and echocardiographic characteristics before surgery. In the AVR+SME group, septal myectomy was performed together with aortic valve replacement.

RESULTS

Septal myectomy is a safe procedure not increasing perioperative risk and morbidity in early postoperative period. At the same time, septal myectomy provides better hemodynamic characteristics in the left ventricular outflow tract and aortic valve prosthesis. Mean LVOT pressure gradient was 2.3 (1.8; 2.9) and 4.6 (3.1; 6.8) mm Hg, (p< 0.01), mean pressure gradient on the aortic valve prosthesis — 9.6 (6.2;14.5) and 12.8 (8.2;19.0) mm Hg, respectively (p<0.01). Survival, complication and redo surgery rate in mid-term period were similar. Septal myectomy improves the mid-term results of aortic valve prosthesis and promotes more effective reverse myocardial remodeling after surgery. Left ventricular myocardial mass index in a year after surgery was 90.7 (75.9; 106.9) and 118.4 (100.0; 142.2) g/m² (p<0.01), respectively.

CONCLUSION

Septal myectomy together with aortic valve replacement improves the results of surgical treatment of aortic stenosis in early and mid-term postoperative period.