ANALYSIS OF THE LONGXTERM 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 β(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<0.05). After surgical treatment, residual mitral regurgitation grade was 1±0.81 in group 1 (1.83±0.75 preoperatively), 0.66±0.5 in group 2 (1.55±0.52 before surgery), and 0.82±0.32 in group 3 (1.76±0.62 before surgery) (p<0.05). The thickness of the interventricular septum was 16.33 ± 3.21 mm in group 1, 15±2.23 mm in group 2, and 13±2.14 mm (n. s.) in group 3. End diastolic value was 60.33±1.52 mL in group1, 75.78±7.87 mL in group 2, and 64.38±5.78 mL (n. s.) in group 3. End systolic value was 14.33±4.04 mL in group 1, 24.18±7.66 mL in group 2, and 26.02±4.46 mL in group 3 (n. s.). Conclusions. The results of the study show that the effectiveness of Alfieri technique in the elimination of the dynamic obstruction of the left ventricular outflow tract was comparable to the widely used Carpentier technique in long-term period (72 months) after combined myectomy. The main advantages of Alfieri technique included shorter time of myocardial ischemia necessary for its implementation and the ability to perform the upper part of the J-sternotomy. No differences in hemodynamics were found between groups for the entire observation period. 

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