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CC BY 4.0 · Thorac Cardiovasc Surg
DOI: 10.1055/a-2434-7627
Review Article

Echocardiographic and Clinical Outcomes of Concomitant Secondary Chordal Cutting to Surgical Myectomy in Hypertrophic Obstructive Cardiomyopathy: A Systematic Review and Meta-analysis

Tijn Julian Pieter Heeringa   *
1   Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
,
Romy R.M.J.J. Hegeman   *
2   Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
,
Len van Houwelingen
1   Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
,
Marieke Hoogewerf
1   Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
,
David Stecher
3   Department of Cardiothoracic Surgery, Medical Centre Leeuwarden, Leeuwarden, Fryslân, The Netherlands
,
Johannes C. Kelder
4   Department of Clinical Epidemiology, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
,
Pim van der Harst
5   Department of Cardiology, University Medical Centre Utrecht, Utrecht, Utrecht, The Netherlands
,
Martin J. Swaans
6   Department of Cardiology, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
,
Mostafa M. Mokhles
1   Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
,
Ilonca Vaartjes
7   Department of Cardiovascular Epidemiology, Julius Center for Health Sciences and Primary Care, Utrecht, Utrecht, The Netherlands
,
Patrick Klein
2   Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, Utrecht, The Netherlands
8   Department of Cardiothoracic Surgery, Amsterdam University Medical Centres, Amsterdam, Noord-Holland, The Netherlands
,
Niels P. van der Kaaij
1   Department of Cardiothoracic Surgery, University Medical Centre Utrecht, Utrecht, The Netherlands
9   Department of Cardiothoracic Surgery, Erasmus Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
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Abstract

In patients who underwent surgical myectomy for hypertrophic obstructive cardiomyopathy (HOCM), additional mitral valve repair may offer additional benefits in terms of further reducing left ventricular outflow tract (LVOT) gradients, systolic anterior motion (SAM), and mitral regurgitation (MR). We performed a systematic review of the literature to evaluate the evidence of surgical myectomy with additional secondary chordal cutting in patients with HOCM. A systematic literature search in MEDLINE and EMBASE was performed until April 2024. The primary outcome studied was postoperative echocardiographic LVOT gradient. A random effects meta-analysis of means was performed for the primary outcome. The secondary outcomes studied were postoperative residual MR grade, 30-day new permanent pacemaker implantation, and in-hospital mortality. From 1,911 unique publications, a total of 6 articles fulfilled the inclusion criteria and comprised 471 patients with a pooled mean preoperative resting LVOT gradient of 84 mm Hg (95% confidence interval [CI]: 76–91). The postoperative pooled mean LVOT gradient was 11 mm Hg (95% CI: 10–12) with a low heterogeneity (I 2 = 44%). The residual LVOT gradient exceeding 30 mm Hg was present in nine (1%) patients. MR grade 3 or 4 at hospital discharge was present in seven (1%) patients. The 30-day new permanent pacemaker implantation rate was 7% and the in-hospital mortality was 0.4%. This systematic review and meta-analysis demonstrate that combining surgical myectomy with secondary chordal cutting can be performed safely and effectively eliminate LVOT obstruction in HOCM patients. Further studies are needed to determine the additive effectiveness of additional secondary chordal cuttings.

Keywords

cardiomyopathy - echocardiography (all modalities applications) - heart valve surgery - mitral valve surgery

Authors' Contribution

T.J.P.H. and R.R.M.J.J.H. contributed to conceptualization, data collection, analysis and interpretation of data, statistical analysis, drafting the manuscript, and critical revision of the manuscript. L.v.H. contributed to data collection, analysis and interpretation of data, statistical analysis, drafting the manuscript, and critical revision of the manuscript. M.H., P.K., and N.P.v.d.K. contributed to conceptualization, analysis and interpretation of data, drafting the manuscript, and critical revision of the manuscript. D.S. contributed to conceptualization, interpretation of data, drafting the manuscript, and critical revision of the manuscript. J.C.K. and I.V. contributed to conceptualization, analysis and interpretation of data, statistical analysis, drafting the manuscript, and critical revision of the manuscript. P.v.d.H., M.M.M., and M.J.S. contributed to conceptualization, interpretation of data, statistical analysis, drafting the manuscript, and critical revision of the manuscript.


Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.


* These authors shared equal authorship.


Supplementary Material



Publication History

Received: 19 August 2024

Accepted: 30 September 2024

Accepted Manuscript online:
04 October 2024

Article published online:
18 November 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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