Methods of surgical correction of hypertrophic cardiomyopathy in adults: from the early origins to modern technologies. Literature review and own research results

You Yuanbing, Kosenkov Alexander Nikolaevich, Ye Haoran, Belov Yuri Vladimirovich

Introduction. Surgical treatments for hypertrophic cardiomyopathy (HCM) have evolved from simple myotomy or removal of a restricted muscle at the point of maximum hypertrophy to the modern extended septal myectomy, which is applicable to virtually all adult patients with HCM and subaortic obstruction. Analysis of changes in left ventricular hemodynamics to assess the shortcomings of previous surgical interventions in order to determine the optimal tactics of surgical treatment of patients with HCM to obtain better results is the subject of this work. Materials and methods. A systematic review of studies published in Russian and English with predominant inclusion (72.5%) of sources over the past 10 years were carried out using the PubMed, ScienceDirect, ProQuest and Google Scholar databases. The review included review articles, retrospective and prospective studies. The use of earlier scientific works (over 10 years old - 27.5%) is justified by the fact that these sources are original with informative content and have no later analogs similar in meaning. The practical part of this study was carried out at B.V. Petrovsky Russian Scientific Center for Surgery, Moscow, which is a department of Sechenov University, where 42 patients (52.4% of women and 47.6% of men) aged 33 to 78 years (mean age 52 ± 9.8 years) were operated on with an obstructive form of hypertrophic cardiomyopathy, SAM-syndrome and severe mitral valve insufficiency during the period from August 2018 to December 2019. Surgical correction of hypertrophic cardiomyopathy in our cohort of patients was carried out by septal myectomy (n = 41) and in 38 patients (90.5%) in combination with mitral valve repairs, 1 patient underwent replacement of the mitral valve with a mechanical prosthesis. Statistical processing of the obtained research results was carried out using Microsoft Excel 2017 software using mean values (M), the reliability was determined using the Student's test, and its critical level in this study was taken equal to 0.05. Results. In our cohort of the operated patients, the weight of the excised obstructive substrate varied from 1.23 gm to 12.16 gm and averaged at 3.31 ± 0.37 gm. We established a decrease in the mass of the left ventricle by 17.0%, the mass index of the left ventricle by 16.9%. In all examined patients (n = 42, 100%), resolution of the SAM syndrome was ascertained. There were no cases of hospital mortality. In 2 cases, complications in the form of paroxysm of atrial fibrillation were documented. Conclusion. Our data indicate good results of surgical correction of obstructive hypertrophic cardiomyopathy and mitral valve insufficiency, and the chosen method and volume of obstructive substrate resection is optimal for adequate hemodynamic restoration.

Keywords:obstructive hypertrophic cardiomyopathy, SAM-syndrome, gradient in the left ventricular outflow tract, septal myectomy, mitral valve repair.