Analysis of the long-term results of combined myectomy in patients with hypertrophic obstructive cardiomyopathy

The article is dedicated to the assessment of long-term results on prevention of systolic anterior motion of the mitral valve (SAM-syndrome) by Edge-to-Edge Alfieri technique without support ring and by Carpentier sliding leaflet technique with support ring implantation in patients with hypertrophic cardiomyopathy with obstruction of the left ventricular outflow tract. Materials and Methods. The study comprised 22 patients with clinical signs of obstruction of the left ventricular outflow tract. The median age was 52.81±15.57 years (23-73 years). All patients had signs of obstruction of the left ventricular outflow tract with an average gradient of 85.5±25.7 mm Hg. Surgical treatment was performed due to the ineffectiveness of therapy with b-blockers. Patients were randomly assigned to 3 groups: group 1 included 7 patients who underwent isolated septal myectomy; group 2 included 9 patients who underwent septal myectomy combined with Edge-to-Edge Alfieri technique trough transaortic approach; group 3 included 6 patients who underwent septal myectomy combined with mitral sliding valvuloplasty with annuloplasty ring by Carpentier method. Results. All patients underwent dynamic observation for up to 72 months. In the early postoperative period, one patient in group 1 required the implantation of a dual chamber pacemaker due to complete atrioventricular block. In group 2, 4 patients required implantation of a dual-chamber pacemaker. Patients of group 3 did not require pacemaker implantation. After surgery, mean left ventricular outflow tract gradient was 24.95±12.98 mm Hg in group 1, 16.62±13.06 mm Hg in group 2, and 18.36±15.24 in group 3 (p