Hypertrophic Obstructive Cardiomyopathy: Should Septal Myectomy Be Combined with Anterior Mitral Leaflet Extension? A Randomized Controlled Trial

H. Abdel kareem Hussein, M. Alhussaini, A. AbdelWahab, M. El Haish, M. Mahmoud Moustafa
Cardiothoracic surgery department, Faculty of Medicine. Assiut University, Assiut, Asyut

Purpose: Hypertrophic obstructive cardiomyopathy (HOCM) involves complex challenges due to asymmetric left ventricular hypertrophy, LVOT obstruction, and mitral valve issues like SAM and MR. This study compares outcomes of extended septal myectomy alone versus combined with anterior mitral leaflet extension (AMLE) in HOCM patients with severe MR without intrinsic MV disease.

Methods: This is a single center prospective randomized controlled trial included 80 patients with HOCM and grade ≥3 MR, randomized into two groups: Group I (40 patients) underwent septal myectomy alone, and Group II (40 patients) underwent septal myectomy with AMLE. Exclusion criteria included intrinsic MV disease, prior alcohol septal ablation, and the need for additional cardiac procedures. Preoperative, intraoperative, and postoperative evaluations were conducted, including echocardiographic assessment of MR and SAM severity.

Results: Both groups showed significant improvement in NYHA class and reduction in medication usage postoperatively. Group II exhibited more pronounced improvements in MR grade, SAM grade, and LVOT pressure gradient. While operative, cardiopulmonary bypass, and aortic cross-clamp times were longer in Group II, this did not lead to increased complications or extended hospital stay. Follow-up at three and six months demonstrated sustained improvements, particularly in Group II.

Conclusion: In patients with HOCM and severe MR without intrinsic MV disease, adding AMLE to septal myectomy significantly enhances functional status, reduces SAM, and improves MR and LVOT gradients compared to septal myectomy alone. This suggests that AMLE may provide additional benefits in managing severe MR associated with HOCM.

Identify the source of the funding for this research project: none