Anterior leaflet retention plasty for treatment of systolic anterior motion and mitral regurgitation in hypertrophic obstructive cardiomyopathy

B Nasseri; H Siniawski; EM Delmo Walter; M Kukucka; H Kuppe; R Hetzer

doi:10.1055/s-0029-1246957

The Thoracic and Cardiovascular Surgeon, Table of Contents

Anterior leaflet retention plasty for treatment of systolic anterior motion and mitral regurgitation in hypertrophic obstructive cardiomyopathy

B Nasseri ¹, H Siniawski ¹, EM Delmo Walter ¹, M Kukucka ², H Kuppe ², R Hetzer ¹

¹Deutsches Herzzentrum Berlin, Herz-, Thorax- und Gefäßchirurgie, Berlin, Germany
²Deutsches Herzzentrum Berlin, Institut für Anästhesiologie, Berlin, Germany

Abstract

Background: Subaortic septal myectomy (SSM) is the treatment of choice for patients with hypertrophic obstructive cardiomyopathy (HOCM) with high left ventricular outflow tract (LVOT) gradients. However, systolic anterior motion (SAM) of the anterior mitral leaflet (AML) in these patients leads to mitral regurgitation (MR) and insufficient release of LVOT obstruction after SSM. We investigated the results of combined SSM and anterior leaflet retention plasty (ALRP) in adult HOCM patients with SAM.

Methods: SSM and ALRP were performed in 25 adult HOCM patients at a mean age of 48.5±15 years. All patients received cardiac catheterization and echocardiography evaluation prior to the operation, before discharge and at follow-up. Mean follow-up was performed after 5.5±4.3 (range: 0.9–14.4) years.

Results: There was no perioperative mortality. Ten percent showed mild SAM at follow-up. Survival after 1, 5 and 10 years was 100%, 82.2±6.6% and 60.9±7.7%, and 30 days, 1 and 5 year freedom from reoperation was 92±5.4%, 87.8±6.6% and 83.2±7.7%. Mean LVOT pressure gradient decreased from 84±32mmHg to 19±11mmHg postoperatively (p<0.001). MR improved from grade 2.2±1 to 0.6±0.7 and NYHA classification from class 3±0.6 to 1.7±0.8at follow-up. Mitral stenosis was not observed.

Conclusions: Combined SSM and ALRP is a safe and effective therapy in HOCM patients. It prevents LVOT obstruction caused by SAM and improves MR. Mid-term freedom from reoperation and survival is good.