Does concomitant mitral valve surgery compared to septal myectomy alone improve survival and echocardiographic outcomes in patients with hypertrophic obstructive cardiomyopathy?
Concomitant mitral valve surgery during septal myectomy for HOCM provides effective and durable LVOTO relief comparable to myectomy alone, though with a potential risk of reoperation for recurrent MV dysfunction.
BACKGROUND Due to variable involvement of mitral valve(MV) anomalies in hypertrophic obstructive cardiomyopathy(HOCM), MV repair may be added to septal myectomy. This study reports on our experience with HOCM surgery, including the effect of MV surgery. METHODS The HOCM population was divided per treatment in group 1=septal myectomy/ablation only, and group 2=septal myectomy + MV surgery. Clinical endpoints as survival and reoperation rate, and echocardiographic results were compared. RESULTS The study comprised 47 patients(group 1=18 - group 2=29). Group 2 showed more MV anomalies(group 1:29% - group 2:79%, p=0.023) as increased leaflet length and annular calcification (group 1:0% - group 2:17.2%, p=0.062) and SAM-related MR(MR ≥ 2: group 1=17.7% - group 2=75.8%, p 19.5±9.3 mmHg - group 2: 69.0±42.3 > 19.1±8.5 mmHg), which was maintained during FU(group 1: 11.2±3.8 mmHg - group 2: 12.2±6.3 mmHg). CONCLUSION Although septal myectomy remains the cornerstone in the treatment of HOCM, a significant MV contribution to the LVOTO is observed in many patients, often amenable to MV repair. LVOTO relief by septal myectomy with or without MV surgery is effective and durable, however at a potential risk of reoperation for recurrent MV dysfunction after MV repair.
Bové et al. (2026) studied this question.
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